Smallpox: Are We Kidding Ourselves?

SMALLPOX: ARE WE KIDDING OURSELVES?

 That we killed it?

It is an old disease, but not a biblically listed scourge [maybe the population was too low].  But it does seem to be reflected in the older Egyptian record.  And there were plenty of people and epidemics on that river down there in the desert [or so their mummies seem to be saying].  And smallpox may have killed more people than any other disease.  30% mortality to those infected by its most vicious formulation!

It is gone now, right?  And we did it, right?  The almighty, all right human race killed smallpox?  That is our hubris speaking.  We suffer that human characteristic like it is an epidemic.  So let’s look at the history of these smallpox infestations and see what they did to us.  Maybe that will help us understand things differently, and allow us to deal with such modern monsters more effectively!

And your first question, we answer immediately!  It is a virus [two, really, Variola major and Variola minor].  And remember, antibiotics don’t work on viruses.  That is part of the challenge today in dealing with the Covid-19 coronavirus.  So maybe some of this discussion will sound familiar.

Many say that viruses aren’t living things at all.  If not, then maybe we really are suffering a real zombie attack! However, viruses do use you to produce copies of themselves [that’s why Covid-19 is so dangerous and effective].  For me, reproducibility pretty much gets them into life’s kingdom.  Parasitic life forms feeding on your body [consider proteinaceous prion infections to really test that logic!].

Investigating the origin and spread of this disease is interesting to the epidemiologist.  And such an inquiry requires many talents of history and science.  For example, our evidence of early Egyptian contamination may only be based on the pustules and scarring of three ancient Egyptian mummies.  Those include one of the 18th Dynasty [ca. 1500 B.C.], and a Pharaoh himself, Ramses V [died 1145 B.C.].

Early evidence on the Indian subcontinent relies on the meaning of the Indian word, “Masurika.”  That term may have been, in earlier times, lumped together with smallpox, chickenpox, and measles.  Alexander the Great invaded India in 326 B.C. and suffered through a disease outbreak that included “scabs” in its description.

Ahrun of Alexandria [an ancient center of Greek learning in Egypt] described the difference between smallpox and measles in the 6th Century A.D..

“When the smallpox pustules are white and red, they are healthy; when green and black, malignant; and if, after a time, the eruption of smallpox and measles changes to a saffron colour, and the fever moderates, good hopes may be entertained; but if these eruptions appear during a frenzy fever, they are fatal.”  (Smallpox and Its Eradication, World Health Organization, 1988)

And here is one I didn’t know.  The Islamic “Year of the Elephant.”  Around the year 570 A.D. [which may have also been the birth year of the Prophet Mohammed], an Ethiopian-backed Yemeni force was sent to attack Mecca.  The Army was devastated by an epidemic of rash and illness, ending Ethiopian control in Arabia.  Was it smallpox or Divine intervention?  The Qur’an, in Surah 105, states:

“Seeist thou not how the Lord dealt with the people of the elephant?  Did he not make their treacherous plan go astray?”(The Meaning of the Holy Qur’an; Amana Publications, 1422 AH/2001 AC)

What about the Plague of Athens in 430 B.C. that killed Pericles?  Hard to know, but that the disease was unknown to them.  Current consensus?  Typhus?  Typhoid?  Bubonic Plague?  Smallpox?  It is not really clear.  It lasted at least four years and decimated the Athenian Army and killed, perhaps, 100,000 people [one-third of the population].

How about the Antonine Plague of 165 A.D.?  It socked the entire Roman Empire for fifteen years, returning again to devastate, 70 years later.  This one was probably smallpox.  Galen’s description, at the time, included blackish diarrhea, foul breath, and red and black skin eruptions all over the body.  Coughing, vomiting, fever, and swollen throat.  Galen said further, “Of some of these which had become ulcerated, that part of the surface called the scab fell away and … became scarred over.”  Those that survived remained that way for life, but were immune to further infection.

As many as 2,000 a day died in Rome.  Maybe 25% died throughout the land [out of a total population of about 60 million].  Perhaps smallpox hastened the fall of the Roman Empire.  It was spread by aerosols and droplets.  Sound familiar?

But once it got to Europe, the disease kept cooking.  In 1438, there was an epidemic in Paris, and in the early 1600s, smallpox raged all across Europe.  That was when we recorded its first presence in Russia.

Before 1492, it was absent in the “New World” of the Americas.  But it quickly spread, after the Spanish rediscovered it, from Hispaniola (1507) to Mexico (1520), Peru (1524), and Brazil (1555).

America was “virgin” territory, and the disease would have its way here.  By the time Pizarro encountered the Inca King, Atahualpa, in 1532, he was fleeing a smallpox epidemic that had killed his Emperor father, and his eldest son, the heir apparent, that left the two younger brothers to fight for his reign.  Does smallpox explain how Pizarro, with 168 men, could have captured Atahualpa when he was surrounded by 40,000 of his warriors?  Not completely, but it set the stage for his defeat.

General Jeffrey Amherst of the British Army in America is another matter.  During the Native American rebellion, led by Pontiac in 1763, it is alleged that Amherst facilitated spreading smallpox pus on blankets that were then distributed to the Native American populations.  In one letter, he wrote, “Could it not be contrived to send the smallpox among the disaffected tribes of Indians?”  Biological warfare begins.

George Washington contracted smallpox when he was 19, in 1751.  Washington, in 1777, would describe smallpox as more fearful, “than … the Sword of the enemy.”

The Native American populations were stricken especially hard in 1801 and 1836, just as our nation was looking to expand westward.  And smallpox was a scourge throughout the modern era.

President Lincoln became infected in the winter of 1863, with symptoms showing on the day of his Gettysburg Address.  Had he died then [and he became very sick], would the nation be different today?

And have you ever looked closely at a picture of Joseph Stalin?  What would the world have looked like if he had died then?

But before we come to conclusion, and postpone the description of “Variolation” and “Vaccination” for a later discussion, let us more specifically describe the agent of this smallpox disease.

According to the Oxford English Dictionary, “virus” is a Latin word for “slimy liquid, poison, offensive odor or taste.”  Citing a 1599 writing, they give this as an example, “You … have … spit out all the virus and poyson you could conceiue, in the abuse of his … person, [sic].”  By 1900, the word had been used to describe unknown infectious agents that could pass through filters that would otherwise trap bacteria.  The search was on!

When we found them, we found that they were essentially bits of genetic material cloaked in a protein sheath.  We classify them into taxonomic families based on the type of genetic material, its replication and envelope.

Smallpox is a member of the Poxviridae.  It is relatively large, oval in shape, and enveloped by a lipoprotein membrane protecting a dumbbell-shaped wrapping of DNA and protein.  The genetic material is relatively long, containing about 185,000 of the coding nitrogenous base pairs.

But this virus is not a “zoonosis.”  That is an organism that has jumped from animals to the human population [hence our current interest in bats, pangolins, and Covid-19!].  Smallpox is not thought to maintain its presence in animals outside of the human population [Covid-19 is a zoonosis, which makes it a continuing concern].  So the World Health Organization (WHO) set out to eliminate smallpox completely from the entire human population.

In 1947, the disease had broken out again in New York City.  The scientific and political mobilization toward citywide vaccination is instructive in our current time of pandemic.  A fictional “Film Noir” movie was based, in part, on that experience.  “The Killer that Stalked New York,” made by Columbia Pictures in 1950, is interesting and forgotten.  We should pay more attention to the past.

And what of the WHO’s efforts to exterminate the smallpox virus?  In their May 1980 magazine cover for World Health was a banner stating, “Smallpox is Dead!”  The WHO began its campaign in 1958, when 63 countries had reported 280,000 cases.  And now, forty years later during our current pandemic crises, Dr. Anthony S. Fauci [long-time director of the National Institute of Allergy and Infectious Diseases (NIAID)] stated that the only human virus that we have ever exterminated is smallpox.  And we did it with vaccines and coordinated world efforts.  Let us hope that our future as a species can improve on that record!

I finish here with a question.  If there was a “smallpox,” is there still a larger pox extant?  I will let you discover that for yourself, as part of our continuing exploration of human pandemics!

 

 

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