Smallpox was an unforgiving disease that left behind a trail of blistering rashes, high fevers, deep scars, and staggering death rates. But in a remarkable global effort, science fought back for the eradication of smallpox, and we had a massive vaccination campaign. This was a huge win for public health.
Let’s dive into the world of smallpox, what this condition was, how it spread, its terrifying symptoms, and its treatment.
Let’s start with the history of smallpox.
We don’t know exactly where and how smallpox originated. But we do know that it took 3000 years of suffering before this disease was eradicated. We have seen Egyptian mummies with telltale rashes. There are ancient Chinese texts written in the 4th century CE and texts in Asia Minor, and across the globe, with mentions of the disease.
As civilisations expanded and trade routes opened, smallpox spread like wildfire. By the 11th century, it had marched through Europe with the Crusades, and by the 16th century, it was ravaging the Americas through colonisation and the slave trade.
Early efforts to fight smallpox included variolation, a risky method of exposing people to the virus in a controlled way. Then came a turning point. In 1796, Edward Jenner developed the first smallpox vaccine using cowpox. His experiments marked the beginning of immunology.
The real breakthrough came in 1967, when the World Health Organisation launched an intensified global eradication program. Through mass vaccinations, surveillance, and community outreach, the disease was finally cornered.
The last natural case occurred in 1977, and by 1980, smallpox was officially declared eradicated. Today, only two labs, one in the U.S. and one in Russia, are authorised to store the variola virus, preserving a relic of one of humanity’s greatest victories.
The smallpox symptoms unfold in dramatic stages. It started out as a flu and ended with a disfiguring rash. The first wave of symptoms includes intense headache, high fever, overwhelming fatigue, and back and stomach pain. You will also be vomiting for a few days. Then, the rash starts to appear, first from inside the mouth and throat. These rashes then spread to the face, torso, arms, and legs. In just one day, your entire body will be covered in rashes.
The red spots in the mouth will become painful sores. On your skin, the raised bumps will be filled with pus, leaving a dent in the centre. Eventually, they will develop into firm pustules, which will then crust over and scab. As they fall off in a week, deep scars will be left behind.
Smallpox came in four types:
Each form was devastating, but ordinary smallpox caused the most cases. Its symptoms and the scars it left behind defined centuries of suffering before eradication ended its reign.
The deadly culprit behind smallpox is the variola virus, a fearsome member of the orthopoxvirus family. It exists in two forms: Variola major, the more severe strain with a higher fatality rate, and Variola minor, a milder version with fewer complications.
Under a microscope, the virus appears brick-shaped with a dense core that resembles a dumbbell. This core holds the virus’s double-stranded DNA, along with proteins crucial for hijacking the host's cells and forcing them to reproduce more viral copies.
Once a person is exposed, the virus hides in the body during a silent incubation period of about 12 to 17 days. No symptoms appear at first, but then comes the storm. High fever, fatigue, and body pain strike, followed by a rash that spreads from the face to the limbs.
Though now eradicated, variola was once one of the most feared viruses in history, claiming millions of lives before the invention of the smallpox vaccine finally ended its deadly legacy.
Smallpox was a fast-spreading, airborne disease caused by the deadly variola virus. Just being near someone infected was enough to put others at serious risk.
The virus mainly travelled through tiny droplets released when an infected person coughed, sneezed, or even talked. Close, face-to-face contact made transmission almost inevitable.
But the danger didn’t stop there. The infection could also spread through:
In crowded spaces and unvaccinated communities, smallpox could sweep through entire populations with terrifying speed. This contagious nature is one of the key reasons it became one of history’s most feared diseases, until the smallpox vaccine broke the chain of transmission forever.
There’s no cure for smallpox, and no treatment can make the virus go away. Instead, care focused on helping the body survive the infection and preventing its spread. Once symptoms appeared, supportive care became the only line of defence.
First and foremost, isolation was critical. Patients had to be kept apart until every scab had fallen off, a process that took 3 to 4 weeks, to stop the variola virus from infecting others.
Doctors focused on:
In recent times, antiviral drugs such as tecovirimat and cidofovir have been stockpiled for emergency use. Though not widely available, they may offer some benefit during an outbreak.
If smallpox was suspected but not confirmed, patients were vaccinated, especially if housed with others who had confirmed cases.
In large outbreaks, home care was encouraged to prevent hospital overload. But when possible, hospital admission ensured better infection control and care.
(Session 2026 - 27)