Grace Mahaffey

Smallpox: A Disease that Shaped a Nation

Disease has long been a neglected catalyst of history, especially smallpox. Yet, with a death toll
surpassing 10 billion, on numbers alone, one can see it has certainly made its impact. Though it has taken
many, the vicious disease has done much more than just seize the lives of billions. It has had a hand in the
battles won, the political power held, the laws enacted, the people's view on religion and health care and a
great deal more.
Smallpox is thought to have originated around 12,000 years ago, with the advent of sedentary
farming, either in the Asian subcontinent of India or Egypt, where its reign of terror began. 1 The earliest
evidence of smallpox in human history was on Pharaoh Ramses V, who ruled Egypt in the 20th dynasty,
around the 1140s BCE.2 Although the circumstances of his death are unknown, it is clear that he had been
plagued by the disease. As the world became more interconnected and trade became more globalized,
goods were not the only things being exchanged between nations.
By 1000 AD the disease had spread to Chinese Empire. This is where the earliest attempts of
variolation -- or the process of deliberately introducing smallpox material to the skin as a means of inducing
a less severe infection than naturally-acquired smallpox -- began.3 Although over the next few hundred years
as the disease continued to spread, the practice of variolation did not have the same fate.
With the end of the Renaissance, European civilization was once again growing and its populations
became more stabilized; as a result, smallpox recurrently became an endemic virus. It presented itself in two
main forms: Variola Major and Variola Minor.4 The most common of the two forms was V. Major had a death
rate of 30%, whereas the lesser form V. Minor only killed around 1% of those infected. Infection was passed
between people generally through inhalation or contact with abraded skin. The disease would present itself
7-17 days after the initial infection with a high fever, body aches and occasional vomiting. This would
progress to a tongue/mouth rash that would develop into open sores; the infected person is now contagious.
The sores would become bumps or smallpox, which were accompanied by severe itching. Finally the pox
would scab over, which meant that the patient was no longer contagious. If they survived they would be
forever scarred by the telltale mark of the pox.5
With smallpox so widespread by the 1600s it was hard to find someone who had been unaffected
by the disease. Then, in 1721 when a smallpox epidemic struck England, Lady Mary Montagu, who had
seen the process of variolation while in Turkey, persuaded Caroline, Princess of Wales to have the
technique tested on orphans and prisoners.6 With the success of these trials and the approval from King
George I, variolation became widely accepted throughout Europe.7 While smallpox had been modifying the
old world for millennia, its revolution of history across the Atlantic had just begun.
First brought over by the Spanish Conquistadors in the late 16th century, smallpox could be
attributed to the annihilation of entire civilizations, a prime example being the Incan Empire. Facing more
than 200,000 men, the Spanish had never seen an army so large. They retreated, but came back months
later to find little resistance and the streets lined with bodies. Smallpox reduced the centuries-long
undefeated army and secured the Spanish conquer of the Incan Empire. 8 It was soon realized that the

Edward Jenner and the history

of smallpox and vaccination Stefan Riedel, 2005

https://www.youtube.com/watch?v=Jrn2fFBh924
3
http://www.historyofvaccines.org/content/timelines/smallpox
4
Handbook of Chemical

and Biological Warfare Agents Hank Ellison

5
http://www.bt.cdc.gov/agent/smallpox/overview/disease-facts.asp
6
Lady Mary Montague on Smallpox in Turkey [Letter]
7
http://www.unofficialroyalty.com/featured-royal-date-august-20-1783-death-of-prince-alfred-son-ofking-george-iii-of-the-united-kingdom/
8
https://www.youtube.com/watch?v=2u3WPjYa-f4
1
2

savage disease was precipitating even deadlier results on this side of the world. Those native to the
Americas were facing death rates of 70%-90% due to smallpox, opposed to the mild in comparison rate of
30%.9 This trend continued as the English and French established their presence farther north.
At the beginning of the 17th century the Native American population in North America was
estimated to be approximately 20 million, but only 280 years later, the 1680 census exhibited that the
population had been reduced to a measly 339,000.10 While the millions of deaths may not all be the fault of
smallpox, the disease certainly made a hefty contribution. The first recorded smallpox outbreak in North
America was in 1617, and only a few years later the Pilgrims began to settle. Much of the land that they so
easily acquired was uninhabited due to the recent pox outbreak. John Winthrop, a Boston colonist,
described the territory saying, for the natives, they are near all dead of the smallpox, so the Lord hath
cleared our title to what we possess.11 Entire native tribes had dismantled in the years previous due to the
raging disease, and those that remained were far too weak to resist the immigration. The so called manifest
destiny of the new settlers was being procreated by none other than infectious disease.
However, some argued that the manifest destiny was very much real and that smallpox was actually
the will of God. During the outbreak of 1633 a Puritan clergymen by the name of Mather said that 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 at Saugust, who were before that time
exceeding numerous. Whole towns of them were swept away, in some of them not so much as one Soul
escaping the destruction.12 Mather was not alone in his belief that smallpox had been an endowment from
God. Many praised God for the disease, offering no remorse for the lives of the Natives that were being
taken. One man, William Bradford a prominent political figure, even went as far as to compare the ill Natives
to rotting sheep.13 By wiping out the Indians, smallpox unveiled resources and land previously controlled by
the unfriendly natives; the Europeans could and did colonize many areas virtually unchallenged.
As if the number of casualties was not high enough from naturally occurring cases of smallpox, it is
possible that British troops purposely infected Natives as a war tactic. In a letter to General Amherst,
Colonel Bouquet who was leading British troops in Pontiacs Rebellion, suggested to try to inocculate [sic]
by means of blankets that may fall into their hands, taking however not to get the disease [himself]. 14 While
it is not known if this exact plan was ever carried out, it is very possible that it was one of the first acts of
bioterrorism. But, the contention between the colonists and the Indians was not the one being affected by
the disease.
In 1690, with the help of the native Iroquois League, the English prepared themselves against the
French in a battle over Quebec. But, when nearly 300 Iroquois Indians fell dead infected with smallpox, they
refused to continue their assistance, and pulled all their men from the battle. This effectively sided the victory
to the French. Smallpox helped Quebec to remain in the hands of the French. A smallpox outbreak in the
1640s weakened the Huron League much more so than the Iroquois. Natural Selection was now deciding
the fate of the two Leagues. Thus, when the Iroquois attacked the long strong Hurons in 1647 they had an
easy victory. Alas, their dominance could not be long sustained. Subsequent smallpox outbreaks in 1649,
1663, and 1679 forced the Iroquois League to shift its focus from that of war, of conquer, of being the most
powerful and most strong to that of just surviving, mourning and burying the dead, and fearing for the living.
Smallpox had no sense of boundaries; it affected the native and the white man alike. While it was
not an endemic virus in early America, as it was is most other affected areas of the world, primarily since the

The Story Of... Smallpox and other Deadly Eurasian Germs

United States 1860 Cencus
11
John Winthrop Describes Life in Boston, 1634
12
Increase Mather Smallpox 1633
13
William Bradford on the Great Sickness among New England Indians, 1633
14
http://explorepahistory.com/odocument.php?docId=1-4-25
10

size of the populations were not large enough for there to consistently be new hosts for the virus, it became
clear that smallpox still posed a sizeable threat to those living in the New World. This prompted the first
medical publication in the Americas. Thomas Thacher of Boston wrote A brief rule to guide the
Common-People

of New-England how to order themselves and theirs in the Small Pocks, or Measles in
1677.In this book he explained how the temperature of the patient should be kept down, the diet that
benefited them best in this time, and dispelled old wives tales of how to cure the disease, inspiring an entire
era of medical self help books and at home treatments. 15 This led to the popularization of another book in
the colonies: Dr. John Tennents Every Man His Own Doctor. It promised plain and easy means for
persons to cure themselves of all distempers...with very little charge. The list ranged from rabies to a cough,
from a sore throat to smallpox. 16 With Dr. Tennents book one had to fear no sickness; anything could be
cured.
Not only did smallpox influence the medical culture, but overarching medical practices and
procedures as well. In 1647, Boston enacted laws of quarantine for infected ships in the Boston harbor. It
was not until the last of the scabs had fallen off all of the passengers or the dead had been buried or
disposed of at sea that the ships were allowed to dock.17 This was just the beginning of a long debate over
the presence the government should have in medicine and health care. While few argued that ships should
be held until cleared disease free, raging debate over the newly introduced smallpox variolation began in the
new world.
Inoculation was first introduced in Massachusetts in 1721, around the same time that it became
known in England. Just as those from their motherland, the colonists did not initially accept the medical
practice. It soon grew to have a bad reputation; many rumors circulated saying that one would die just as
regularly as from the naturally occurring virus. This in combination with the fact that many thought the
process was immoral, a suggestion of the enemy of all righteousness or basically calling upon the devil,
halted its development. Some even went as far as to accuse doctors of concealing or diminishing the true
number of deaths occasioned by variolation and magnifyi[ng the] number of those who died from the
disease in the common way.18
With support from prominent political figures Benjamin Franklin and Alexander Hamilton in his book
A Defense of Dr. Thompsons Discourse, variolation began to gain some traction in the colonies.19
Pennsylvania was the first of the provinces to adopt a system of regulations for the protection of the
community against sickly vessels, as well as for the erection of a hospital to prevent the spread of
contagious diseases. Yet 20 years after these measures were set in place, the governor of Pennsylvania
described the state of the colony saying that smallpox was so prevalent that the whole town will soon
become a hospital. This is because even though variolation was practiced it had still not become
widespread. The theory, known today as herd immunity would soon develop. It was thought that if a high
enough percentage of people were inoculated, then the disease would no longer be prevalent.20 So in 1774
several doctors, alarmed by the great number of poor children who had contracted smallpox, established a
society for inoculating the poor free of charge.21 Thus, doctors began their campaign for required
variolation.
This controversy over variolation not only influenced the medical but also the political realm. As the
intensity of the disagreement grew, people became very passionate about their stance. One was either
15

A brief rule to guide the Common-People of New-England how to order themselves and theirs in the
Small Pocks, or Measles by Thomas Thacher, 1677
16
Every Man His Own Doctor Dr. John Tennent, 1727
17
http://academic.udayton.edu/health/syllabi/Bioterrorism/4PHealthLaw/PHLaw00c.htm
18
The Early history of medicine in Philadelphia George W. Norris, 1886 101-107p.
19
A Defense of Dr. Thompsons Discourse Alexander Hamilton, 1751
20
http://www.who.int/about/bugs_drugs_smoke_chapter_1_smallpox.pdf
21
The Early history of medicine in Philadelphia George W. Norris, 1866 101-107p.

pro-inoculation or against it; there was no inbetween. Politicians began to use their position on the matter as
political capital; those seeking to gain more support from more devout religious groups would criticize
variolation; those appealing to more liberal, or more educated peoples would show their support. And once a
political leader that had a specific viewpoint was elected into office, the future support of variolation and
subsequently the number of people that were treated was impacted.
Once politicians publicized the argument concerning variolation, it extended beyond that. Eventually
the dispute evolved into something much broader; one was either on the side of God or on the side of
science, thusly, beginning the religious war on science. Many people, through a combination of the ideas
of politicians and local religious leaders, were force-fed the conclusion that the Christian religion and science
could not coexist. One pastor said that by being inoculated one would tempt the Almighty by inflicting
distempers without his permission.22 Smallpox, immune to the ethical dilemma, continued to persist.
Another great venture that possibly had its roots in smallpox was the American Slave trade.
Previous to the mass amounts of African slaves being brought across the Atlantic, Native American slavery
was present in large numbers.23 Alas, the high death rate among those native to the Americas posed a
problem; almost all the slaves were dying off whenever a wave of smallpox swept through. This coupled with
the knowledge that those in Africa possessed only the standard death rates led to the desire for African
slaves to increase. But while the natural immunity of Africans was significantly lower, the conditions and
treatment during the slave trade, and the means by which they were gathered, caused the presence and
deadliness of the disease to increase tenfold.
The journey many took into Africa to find new slaves spread the disease into corners of the country
that had never seen its wrath before. Isolated native communities previously unaltered with the outside world
were now in for a rude awakening. They were invaded; their strong men and women taken and forced into
lives of slavery, but those who remained suffered a different devastating fate: smallpox. While the invaders
intended to leave nothing behind in these pillaged villages, scarred memories and faces remained.
Even those ripped from their homes and forced into slavery were not spared from the horrendous
affliction. The ships meant to transport them across the Atlantic were perfect breeding grounds for the
disease. The slaves were placed under the deck of the ship, so tightly packed, bodies were practically on
top of each other. The close proximity added to the already intolerable heat, and with the dampness, due to
them being within the belly of a ship, the stench became pestilential.24 Disease festered in these
conditions. Additionally, the slaves were underfed which weakened their immune systems allowing their
susceptibility to the ever present disease to increase. Smallpox alone killed 25% of those being brought over
from Africa, which subsequently only heightened the number of slaves originally taken.
Centuries later, after smallpox was contained, its presence can still be clearly seen. It can be seen
through the battles won, like the battle of Quebec. While this was only a single battle won, an ulterior
outcome could have changed history; if Quebec would have fallen to British control, it is very possible that it
would not have remained loyal to the crown and separated during the American Revolution, consequently
changing the bounds of our modern day countries. It can also be seen how we treat modern day
vaccination; the debate over variolation started a disagreement that still persists today. Back in the times
when smallpox ran rampant, the reports from a single innaccurate source developed into mass hysteria
concerning variolation, and people thought that it would harm them instead of benefit. Today, a single
published claim from Andrew Wakefield that the MMR vaccine was linked to autism spectrum disorders
caused people to panic. Many parents stopped vaccinating their children, which in recent years has led to
the reemerging of once controlled diseases, like measles.

The Early history of medicine in Philadelphia George W. Norris, 1886 111p.

https://www.gilderlehrman.org/history-by-era/origins-slavery/essays/indian-slavery-americas
24
http://americanhistory.si.edu/onthewater/oral_histories/life_at_sea/pdf/transcript_equiano.pdf
22
23

Some claim that this was the most devastating medical myth of the last century. But this reaction is
valid; our ancestors for so long had to fear disease; they saw the utter destruction that it could cause. It has
become so ingrained in us to expect the worst when it comes to sickness; it is an evolutionary response. So
it is to be expected that when a claim that vaccination was causing just another sickness or when courtires
across the Atlantic were suffering from an ebola outbreak last year that we, as Americans, would be in
hysterics, even though we were in no real danger.
This disease has also infiltrated science, well beyond medicine. Smallpox started a war on science,
and this idea continues very much into many peoples modern day views. The rejection of sound theories
such as Evolution or the Big Bang are typically instantaneously disregarded by religious followers, under the
assumption that God and science contradict one another. This idea even has developed political agendas.
During the reign of smallpox, when political leaders would take a stance either in support of or against
inoculation, it then developed into religion as political capital. Today, political leaders continue to debate God
as a means of justification, and it seems that Christianity has be a requirement for administration. To this
day, at least in some capacity, all the American presidents have been Christian.25
Smallpox not only impacted the past, but continues to shape the nation. Its influence throughout
many realms of human life has been more powerful than any other force of its kind and beyond. It has
clearly caused changes in medicinal, political, religious, and social practice and ideals, and the longevity of
these has shifted the way humans function and respond to their surroundings. Though the disease has been
contained, it is clear that smallpox has not finished making its mark.

25

http://www.pewresearch.org/fact-tank/2015/02/12/almost-all-u-s-presidents-have-been-christians/