Plagues and Peoples
Smallpox Chapter 9, C.R. 1008-1010, 279-286
Textbook Chapter 9: Smallpox, the Spotted Plague (191)
- Smallpox killed the Aztecs in the war between Cortes (Spaniards) and Aztecs.
- In 1520, an expedition led by Panfilo de Narveez arrived from Spanish Cuba; among the crew was a smallpox-
infected slave. From this initial infection, smallpox spread from village to village throughout the Yucatan –
famine and havoc resulted.
- In the time of Cortes , 3 million Amerindians, 1/3 of total of Mexico, were killed by Smallpox.
- Smallpox also affected the battle between Francisco Pizarro (Spanish) and Atahualpa (Inca Empire) in 1532
because smallpox wiped out most of the Inca Empire in 1526 and they were vulnerable for Pizarro.
- Smallpox spread in advance of the Spaniards’ entry into Mexico and Peru.
- Disease moved ahead of the Spanish and, in effect, smallpox cleared the way.
- In the 20th century only, smallpox killed 300 million people – 3x the # of deaths from all 20th century wars.
- Smallpox has been involved not only with war but also with exploration and migration.
- Smallpox is indiscriminate, with no respect for social class, occupation, or age.
- In Europe, the use of makeup began among wealthy survivors in order to hid smallpox-induced scars.
A Look Back (192)
- When smallpox began to infect humans is not known; it is thought that humans got it from one of the pox-like
diseases of domesticated animals in Asia or Africa, sometime after 10 000 B.C.
- Best evidence of smallpox in humans is found in 3 Egyptian mummies (1570 – 1085 B.C.) – one of which is
Pharaoh Ramses V (five).
- Mummified face, neck, and shoulders of the Pharaoh bear the telltale scars of smallpox: pockmarks.
- Smallpox spread from the West to China, first appearing about 200 B.C.
- Trade caravans assisted in the spread of smallpox, but at time of Christ’s birth, it was not established in Europe
– the populations were too small and greatly dispersed.
- Smallpox was known in Greece and Rome, but was not a health threat till about AD 100 – Plague of Antonius.
- Epidemic started in Mesopotamia and the returning soldiers brought it home to Italy. It raged for 15 years and
2000 deaths daily in Rome. Marcus Aurelius died of smallpox in AD 180.
- Smallpox and malaria contributed to the decline of Roman Empire.
- Records of smallpox in Korean peninsula (AD583), Japan (AD 585), Western Eurasia (8th & 9th century during
Islamic expansion across North Africa and into Spain and Portugal), and Huns were infected in Persia or India.
- In records: smallpox was established in Italy & France in 5th century, but it is believed Huns brought it to
- Christian priest, Ahrun, (AD 622) and Persian physician, Al-Razi, (AD 910) wrote a clear description of
smallpox, differentiating it from measles.
- By AD 1000, smallpox endemic in densely populated parts of Eurasia, African countries (Mediterranean Sea
- Traders, slavers, and caravans helped spread the disease.
- Smallpox reintroduced to Europe through movement of people to & from Asia Minor during Crusades in 12th &
- As Europe’s population increased, smallpox epidemics appeared with increasing intensity and frequency.
- Smallpox serious in England and Europe in 16th century.
- Smallpox went with British and Europeans into newly discovered Americas, Australia, and Africa.
- Smallpox also contributed to the settlement of North America by French and English.
- English used smallpox as a germ warfare in 1763 in war between England and France. Sir Geoffrey
(Commander-in-Chief of North America) sent smallpox-infected blankets to Indians – Indians lost.
- In 1490, smallpox was spread to Southern regions of West Africa by Portuguese.
- Smallpox first introduced to South Africa by ship docking in Capetown in 1713 that carried contaminated bed
linen from India.
- 1st outbreak in Americas – African slaves on the island of Hispaniola in 1518.
- Slaves also brought smallpox to the Portuguese colony of Brazil.
Plagues and Peoples
Smallpox Chapter 9, C.R. 1008-1010, 279-286
- Smallpox 1st recorded in Sydney, Australia in 1789 (year after British established a penal colony there).
- Soon decimated many aboriginal tribes.
The Disease of Smallpox (195)
- Cause is a virus (one of the largest viruses) and can be seen with light microscope with proper illumination.
- Most structure can be seen with electron microscope.
- Outer surface (capsid) – diamond facets, inner – has DNA.
- Virus has 200 genes – 35 = virulence.
- Other poxviruses: monkeypox, cowpox, milker’s node, tanapox, and chicken pox.
- Most of these viruses cause mild disease in humans, with exception of zoonotic monkeypox (indistinguishable
- Smallpox most enters through droplet infection by inhalation, can be acquired direct contact or through
contaminated fomites (inanimate objects).
- Infectious material from pustules can remain infectious for months.
- In mucous membrane of mouth and nose, virus multiplies.
- 1st week: no sign of illness; virus can spread by coughing or nasal mucus. Virus moves on to lymph nodes then to
internal organs via bloodstream. Here virus multiplies again. Virus re-enters bloodstream. Around 9th day, 1st
symptoms appear: headache, fever, chills, nausea, muscle ache, and sometimes convulsions. Person feels quite ill.
Few days later, characteristic rash appears.
- Person is infectious a day before rash appears & until all the scabs fall off. Many die a few days or a week after
the rash appears.
- There are complications from secondary infections (not frequently).
- Infection results in destruction of sebaceous (oil) glands of skin, leaving permanent scars on skin – pockmarks.
- Two types of smallpox virus: Variola major (deadlier form) and variola minor – distinguished by differences in
- Variola major frequently kills 25% of victims; in naive populations (i.e. Amerindians) fatality rate can exceed
- Variola minor had a fatality rate of about 2% & was more common in Europe till the 17th century, when it
mutated to lethal form (possibly from reintroduction from Spanish colonies).
- In 17th century (mostly 2nd half – 20 deaths a week), smallpox was very common in Europe – killed approx. 400
000 a year – cause 1/3 of blindness.
- Smallpox played a role in the British royal houses (the succession of House of Stuart by the House of Hanover).
- By beginning of 18th century, nearly 10% of world’s population had been killed, crippled, or disfigured by
- 18th century of Europe was called the “age of powder and patches” b/c pockmarks were so common. “Beauty
patch” designed to hide skin scars.
Catching Smallpox (198)
- Contagious disease and not zoonotic.
- Estimated that a min. population of 100 000 persons is need to ensure there are enough susceptible persons
born annually to sustain the chain of infection; R0 value has been calculated to be between 5 – 10 for epidemic
- Smallpox spreads quicker during winter in temperate climates & during dry season in tropics.
- Most individuals who were susceptible recovered, were immune, or died: smallpox died down.
- After a while, smallpox came back only to newborns, but would break out as epidemic every 5 – 15 years.
- Mortality was highest among infants, and smallpox can induce abortions in all trimesters of pregnancy.
- Early treatments: prayer and quick remedies. In ancient Africa and Asia, there were smallpox gods and
goddesses for protection.