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by William H. Benson

December 11, 2008

     The World Health Organization certified on December 9, 1979 that small pox had been eradicated. Two years before, WHO officials had vaccinated a hospital cook stricken with the disease in Merka, Somalia, and even though the same officials continued treating all other suspected rashes, they never found another case. A disease that had caused great horror among human beings for centuries was gone.

     Caused by the variola virus, it is spread from person to person through the air by inhaling droplets expelled by someone infected Two weeks later, the person aches, runs a fever, and develops a rash that turns into thousands of pustules. Blindness, disfigurement, and death can occur, but fortunately once infected, a person cannot get the disease again.

     Repeatedly, epidemics devastated Europe, Asia, and Africa over the centuries, and when introduced into North and South America, it decimated entire villages. Cotton Mather, the minister at the Old North Church in Boston during the eighteenth century, observed that beginning in 1630 a smallpox epidemic had appeared in New England every twelve years, with one exception—the year 1714. By 1721, he knew it was due.

     It struck Boston with vengeance in April of that year, when an infected sailor from the ship Seahorse, supposedly quarantined on a nearby island, was seen walking about Boston’s streets. Within weeks, cases began appearing, and people began dying. 

     Cotton Mather struck back. He had heard about a method to prevent the disease from his African servant, Onesimus, who showed Cotton the scar on his arm from when he was inoculated when in his youth and living in Africa among his tribe, the Guramantese.

      “People take Juice of Small-pox; cutty skin, and putt in a Drop; then by’nd by a little sicky, sicky; then very few little things like Small-pox; and no body die of it; and no body have Small-pox any more.”

     Mather wrote about this remedy in a pamphlet he entitled Wonderful Practice and that he dated June 6, 1721. He convinced only a single Boston physician, Dr. Zabdiel Boylston, to try it, and by December, Boylston had inoculated some 300 people. Only one of them had died, a Mrs. Dixwell, but due to other health issues.

     By December of 1721, the epidemic had infected 5889 people in all of New England, and of those 844 had died.

     In the late eighteenth century, inoculation gave way to vaccination when Edward Jenner, an English scientist, began using the discharge from the pox on cows who had cowpox, for he had observed that dairymaids who had had cowpox did not get small pox.

     By the middle of the twentieth century, “mass vaccination” had rid Europe and North America of the waves of a small pox epidemic, but in India, Pakistan, Afghanistan, Brazil, Africa, and Indonesia it was difficult to get 100% of the population vaccinated.

     An outbreak in Nigeria in 1966 began the evolution of a new strategy called “surveillance and containment.” Once notified that a village had a case of small pox, officials would swiftly rush in and vaccinate those immediately close to the infected person and then those that surrounded them and so on in ever widening concentric circles. They discovered that this strategy could break the transmission chain of smallpox, even when less than half the population was vaccinated.

     What eventually eliminated smallpox was a combined approach of using mass vaccination to reduce the disease’s incidence so that surveillance and containment could eliminate the few remaining pockets of outbreaks.

     “The global eradication of smallpox in 1977 ranks as one of the greatest triumphs in modern medicine, science, and public health.” Although two cases of smallpox occurred in England in 1978 as a result of a laboratory accident, it was gone as a naturally transmitted disease.