Even though smallpox is to all intents and purposes extinct, it has been creeping back into the spotlight lately. Since March 2020, when the World Health Organisation (WHO) declared covid-19 to be a worldwide pandemic, everyone keeps talking about smallpox.
It is as if smallpox were one of those horror movie villains who is never quite dead despite having been stabbed, shot, or blown up. We can never be certain that the monster won’t come back from the dead to destroy us. And if the monster really is dead, maybe his second cousin or illegitimate son will take up where he left off.
Is that why smallpox is mentioned constantly in relation to covid? To persuade us that there is a connection between the two diseases? A very frightening connection?
Among the political voices recently urging people to get vaccinated against covid was Fianna Fáil senator, Malcolm Byrne. In a newspaper report he was quoted as saying:
We need to think of all the horrible diseases that we don’t see now, from smallpox to polio, and that is because of vaccines.1
It is not just politicos. Another example is this from Professor Mary Horgan, president of the Royal College of Physicians of Ireland:
Vaccination programmes have saved millions of lives since their inception more than two centuries ago following Edward Jenner’s scientific observation that the cowpox virus protected against smallpox.2
When I was a youngster it was routine for children to be jabbed in the arm as a defence against a number of potentially deadly ailments like TB. What I did not know at the time is that it all started with smallpox. Not that smallpox was the first incidence of a major transmissible disease. But in two important respects it is unique.
Firstly, as the author of a history of smallpox has noted, it is “the only disease that mankind has so far succeeded in wiping off the face of the planet”. Not only that, but, as the same writer points out, “It was smallpox that triggered the discovery of vaccination.”3
In May 1980 the WHO announced to the world that smallpox had finally been eradicated. The man who led the campaign against the disease was an Ohio-born medical doctor named Donald Henderson. In an article marking what the journal editor referred to as “a truly epochal event”, Henderson made it clear that this achievement was a one-off.
I now see no other candidate disease for global eradication – no other disease with the appropriate combination of severity and suitable epidemiologic characteristics and for which we have appropriate and affordable technology to permit eradication.4
In other words, smallpox would not be joined by malaria, leprosy, syphilis, etc., in the roll-call of defunct diseases. And so, to this day, smallpox stands alone.
So what exactly is (or was) smallpox?
When the Black Death or Bubonic Plague faded away in the 17th century, smallpox replaced it as “the most dreaded of all diseases”.5 Although smallpox was around long before then, no one knows how, where, or when it originated. The earliest evidence of its origins is to be found in the remains of Egyptian pharaoh Rameses V who, if he did not die of smallpox, seems to have had the disease judging by the pockmarks found on his mummified face. On the other hand, the absence of any mention of smallpox in New Testament accounts of Jesus healing diseases (like leprosy for instance), suggests that it was not as virulent or as widespread an infection then as it later became.
Tracing the history of smallpox involves a lot of speculation. The similar rash found in cases of measles and chicken pox makes it virtually impossible to distinguish retrospectively one disease from another. It was only towards the close of the 17th century that smallpox itself began to be recorded as a significant threat to life and limb. During the century that followed the disease had a devastating impact on Europe:
The contemporary physician Rosen von Rosenstein stated that smallpox every year killed one-tenth of all Swedish children in their first year of life. With the possible exception of infantile diarrhoea, small pox had become the greatest natural check upon an uncontrolled rise in population.6
It was not just children who could catch smallpox. Young and old, rich and poor, kings and commoners, were all susceptible. Wolfgang Amadeus Mozart and George Washington were two notable survivors of smallpox. The heir to the Portuguese throne, Prince José, was not so fortunate. He died of smallpox in 1788 at the age of 27.
Many of those who recovered from smallpox were left with life-changing injuries. A distressing symptom of this disease was the terrible rash that erupted on the patient’s face. Those who did not succumb to the infection were often left with a multitude of pockmarks that disfigured their appearance, more so even than a bad case of acne. Some were so traumatised when they finally looked in a mirror that they committed suicide. Gareth Williams describes the aftermath of infection:
Unlucky survivors of smallpox had to confront the horror of a rough pitted mask with their eyelids stripped out - a face that, a month earlier, would have made them turn away in disgust - and the realisation that this was how they and the world would see them for as long as they lived.7
Native Americans had their own name for this unwanted ‘gift’ from across the seas. They called it “rotting face”.8
Do you now find yourself agreeing with Senator Byrne in that quote at the top of this article? Are you, like me, shuddering with relief that we do not live at a time when smallpox is an ever-present danger? Imagine developing those horrible pustules on your face, knowing that you might either die or suffer terrible scarring for life. It makes our present troubles seem mild by comparison, doesn’t it?
But what if smallpox were not just a relic of the past, like the dodo, of interest only to anthropologists and historians? Can we imagine a scenario where, rather than covid, it was a revived and virulent form of smallpox that precipitated the worldwide pandemic declared two years ago? Would the official response across the planet have been any different?
It is hard to imagine measures more stringent than those we have seen. The quarantining of entire populations, the enforcement of face-masks on adults and children, the necessity of vaccine passports to eat in restaurants or travel abroad, these are among the restrictions many of us have lived with in recent times. In Ireland, the authorities took these drastic steps because of what they stated to be “the immediate, exceptional and manifest risk posed to human life and public health by the spread of Covid-19”.
We could blame the government for being over-zealous in its approach to the pandemic, but nothing more than that surely. We might even excuse our leaders for their excessive caution in dealing with a threat that was outside their experience. Yet from the start, as I argued here and here, governments seemed more intent on promoting public fear than saving lives. In Ireland, for example, senior politicians and officials exaggerated the number of covid fatalities to make the disease seem far more deadly than it was. Nevertheless, as 2020 gave way to 2021, the screws were tightened further - despite the lack of evidence of an “immediate, exceptional and manifest risk… to human life and public health”.
In short, our government behaved as if today’s pandemic was as dangerous as yesterday’s smallpox. The official response to covid was out of all proportion to the actual threat to citizens. Covid-19 is not smallpox – far from it. But if people were persuaded that it could be as dangerous, they would do virtually anything to avoid it, wouldn’t they?
So the authorities applied our 21st-century pharmaceutical, communications, and legal machinery to combat a fictitious foe created for one reason and one reason only: to instil such fear and confusion in the public mind that people would trade their liberty for safety.
The fictitious foe may have been called covid, but it was really smallpox reborn - or at least its shadow.
More in Part 3.
Gorey Guardian, 4 Jan. 2022.
Irish Examiner, 8 Dec. 2020.
Gareth Williams, Angel of Death: The story of Smallpox (Basingstoke, 2010), pp. xviii-xix.
D. A. Henderson, ‘Smallpox Eradication’, Public Health Reports (1974-), 95/5 (Sep-Oc., 1980), p. 424.
Frederick F. Cartwright, A social history of medicine (London 1977), p. 75.
Ibid, p. 78.
Williams, Angel of Death, pp. 33-4.
Quoted in ibid, p. 2.
The plot thickens!