Victory over Variola ’

Over the past few years, the world has witnessed the final engagement in a long and costly war against smallpox. It now becomes increasingly clear that the war has been won, that smallpox has been totally and we hope irrevocably eliminated from among the plagues of mankind. The last stages of the war were necessarily global-that is, involving cooperation of many nations. The story is unusual in many regards, not the least of which is that it has a very happy ending. For this reason, it merits particular consideration by historians as well as physicians and biologists. Smallpox is certainly an ancient disease. The earliest clinical material still extant is to be found on the mummy of Pharaoh Ramses V, who died about 1160 B.C. A study of the lesions on his face has led physicians to the conclusion that he must have died of acute smallpox. In ancient times the disease was epidemic in the Orient and in India. Curiously, its spread as an epidemic into Europe seems to have been delayed for reasons not entirely clear. It spread through Europe during the Middle Ages and soon assumed its place among the great epidemic diseases. Morbidity and mortality rates were appalling. It is estimated that the usual mortality in an epidemic ranged from 20 to 40% of affected individuals. It is generally believed that no more than 20% of the population of Europe escaped an attack of smallpox. Partially isolated islands were peculiarly vulnerable. It is claimed that one-sixth of the population of Ireland died within a single year of the disease, while 36% of the population of Iceland succumbed in 1707 in a similar epidemic. Although those who survived an attack of the disease were immune, a fact which was early recognized, they also were frequently hideously pockmarked-particularly trouble-