Secondary Resources 1 - What is Smallpox?

variola virus microscopic image

What is Smallpox?

Smallpox is a highly contagious and often fatal disease unique to humans.

It is caused by a virus called the ‘variola’ virus. ‘Variola’ is the Latin word for ‘spotted’ and refers to the small pus-filled blisters that appear on the face and body of an infected person.

(Right) A cluster of variola virus particles as seen under an electron microscope.
© Centres for Disease Control and Prevention

Smallpox was eradicated in a worldwide campaign thirty years ago. But for centuries, it was one of the most feared of all human diseases.

It killed about thirty percent of the people it infected, and caused 300 million deaths worldwide in the 20th century alone.

victim of smallpox epidemic

Infection and Death

Infection spread from person to person by inhalation (breathing), or via saliva or by touch. Infection was also possible via clothing and blankets, which meant you could catch the disease without direct contact with a smallpox victim.

Once in the body, the virus reproduced itself, creating tens of thousands of new viruses within every infected cell. After a 12-day incubation period the virus entered the bloodstream. At this point the victim noticed the early signs of the disease: headaches, vomiting and aching limbs.

(Right) Edwin Davis, a smallpox patient during the Gloucester epidemic of 1896. © The Wellcome Library, London

Three to five days later, the characteristic rash developed, spreading from the face, hands and forearms to the rest of the body.

The rash became progressively more ugly until finally the victim’s body was covered with pustules oozing a straw-coloured liquid. Victims died when the spots become so numerous they overlapped and extended to the throat, causing the sufferer to choke; or when pneumonia set in; or when the scabs became poisonous with bacteria.

It was a cruel disease, hideous to suffer and to watch.

section from painting, by Longhi, c.1752

Survival and Immunity

Smallpox killed about 30% of those it infected.

The majority survived. But many were left either blind, or horribly disfigured. As the smallpox pustules dried up, they left pockmarks that covered the face and body. Paints, potions, beauty spots and veils were all used to disguise smallpox scars.

The Apothecary, by Pietro Longhi, c.1752. © unknown

But those people who survived smallpox had one natural advantage over everyone else – their bodies were now immune to the virus, and they couldn’t catch smallpox again.

For this reason, survivors of smallpox were in demand as servants. Adverts for servants in the 18th century sometimes requested that they should have already had the smallpox ‘in the natural way’.

photo of child victim of smallpox, 1908

A disease of childhood

At least 80 percent of victims of smallpox were under the age of ten. The Germans called it ‘Kinderpocken’, or ‘child pox’.

Children are more susceptible to viral diseases because their bodies lack the resources to fight back; the ability to generate effective anti-bodies increases with age.

A child with smallpox from a medical textbook, 1908. © The Wellcome Library, London

So, in early infancy the death toll is the highest; almost half of children who caught smallpox under the age of four died. But then, by the age of 12, the fatality rate drops dramatically. Teenagers with smallpox have a 90% chance of surviving the disease.

Fatality rates then climb again in later life. For those aged over 60, the fatality rate reaches approximately 30%.


Life mask of Ludvig van Beethoven

Famous victims

Many famous people in history suffered from Smallpox, including three US Presidents: Abraham Lincoln, Andrew Jackson and George Washington. Washington had pockmarks on his face – but these aren’t shown on his official portraits, and there’s no sign of them on his picture on the dollar bill.

Soviet dictator Joseph Stalin recovered from childhood smallpox at the age of seven. His face in adult life was covered with pockmarks, but he insisted photographs were retouched to make them less noticeable.

A life-mask of Ludvig van Beethoven, taken around the time of the 5th Symphony (c. 1806). Note the pockmarks – evidence of smallpox. © The Wellcome Library, London

Mozart and Beethoven both had smallpox as children, and had pockmarked faces throughout adult life.

Other famous victims include Cuitláhuac, the Aztec ruler of Tenochtitlan, Guru Har Krishnan, the 8th Guru of the Sikhs, two Japanese emperors, Kings of Burma and Siam, and (it is believed) the Roman emperor Marcus Aurelius.