Smallpox: The Triumph over the Most Terrible of the Ministers of Death
Annals of Internal Medicine HISTORY OF MEDICINE
Smallpox: The Triumph over the Most Terrible of
the Ministers of Death
Annals of Internal Medicine 15 October 1997. 127:635-642.
Related Letters
Nicolau Barquet, MD, and Pere Domingo, MD
More than 200 years ago, Edward Jenner performed an
experiment that laid the foundation for the eradication of smallpox
and transformed humankind's fight against disease. Smallpox
afflicted humankind as no other disease had done; its persistence
and diffusion were without parallel. The disease brought down at
least three empires. Generations watched helplessly as their
children succumbed to the disease or were disfigured or blinded
by it. Attempts were made to contain smallpox by isolating its
sufferers and, later, by using variolation with varying degrees of
success. However, the definitive solution was not found until
Jenner's work was done at the end of the 18th century. Milkmaids
who had developed cowpox from contact with cow udders
informed Jenner that they were protected from the human form of
the disease; he listened to their folk wisdom and raised it to the
status of scientific fact. Jenner did not discover vaccination, but
he was the first to demonstrate that this technique offered a
reliable defense against smallpox. It was also a reliable defense
against other illnesses, such as poliomyelitis, measles, and
neonatal tetanus, although this was not known in Jenner's
lifetime.
Ann Intern Med. 1997;127:635-642. Annals of Internal Medicine is
published twice monthly and copyrighted © 1997 by the
American College of Physicians.
From Centre d'Assistència Primàaria Gràacia, Institut Catalàa
de la Salut and Hospital de la Santa Creu i Sant Pau,
Barcelona, Spain. For current author addresses, see end of
text.
Smallpox was always present, filling the
churchyard with corpses, tormenting with
constant fear all whom it had not yet 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 (1).
Smallpox has been one of humankind's greatest scourges since
time immemorial. Even illnesses as terrible as the plague,
cholera, and yellow fever have not had such a universal and
persistent impact. Smallpox is believed to have appeared at the
time of the first agricultural settlements in northeastern Africa,
around 10 000 BC (2). It probably spread from Africa to India by
means of Egyptian merchants in the last millennium BC (3). The
earliest evidence of skin lesions resembling those of smallpox is
found on the faces of mummies from the time of the 18th and
20th Egyptian Dynasties (1570 to 1085 BC) and in the
well-preserved mummy of Ramses V, who died as a young man
in 1157 BC (4-6).
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