Panic, confusion, illness, and quarantines have haunted humanity for thousands of years as communities grappled with disease. Among the deadliest scourges humanity faced was perhaps smallpox, which left 300 million in its centuries of existence. Though once dreaded, it has since been wiped from the face of the Earth, never to return. Its eradication showed how determination, experimentation, and education could overcome any health crisis.


The dreaded smallpox virus apparently emerged nearly 4,000 years ago, apparently mutating from a similar virus found in some African gerbils and other rodents. Mild outbreaks occurred among the Egyptian people around 2000 BC, even infecting the pharaohs as the virus was found in their mummified remains. The disease caused high fevers, outbreaks of horrible blisters and postules and would cause death, blindness, or scarring. From what microbiologists can determine by studying its genetic structure, Egyptian traders around 1500 BC unknowingly brought the virus along the trade routes of South Asia into India. The first known widespread outbreak occurred in India in 1500 BC. From India, it spread to China, causing an epidemic in 1142 BC.


An outbreak in the Roman Empire between AD 165 and AD 180 left five million dead. By the fifteenth century, smallpox had embedded itself across the Eastern Hemisphere. Mortality rates as high as 30% were seen, with thousands dying each year and thousands more blinded or horribly disfigured.


The earliest scientific study of the disease was by Rhazes, a Persian physician around AD 900. He noticed smallpox had specific patterns and symptoms and was markedly different than measles or chicken pox, which produced postules as well. He was also the first to recommend quarantines for those showing symptoms to avoid its spread and save lives. Nevertheless, the disease continued to erupt with deadly results.


As the Europeans began moving outward in the fifteenth century, they unknowingly carried smallpox with them. When Hernando Cortes arrived in Mexico to conquer the fabled Aztec Empire in 1519, they brought smallpox. The Aztecs managed to overpower the conquistadores in 1520, but they soon found themselves infected with the horrible new disease, an enemy they could not conquer. Upwards of 8 million people died in Central Mexico. In some areas, smallpox killed up to 90% of those Native Americans infected.


Variolation began to be developed as a preventative, grinding up smallpox scabs into powder to be inhaled by patients. Patients would then receive a mild case of smallpox, recover with few complications, and be immune afterward. Though it carried risk, it greatly reduced the death rate.


Rev. Cotton Mather, perhaps the embodiment of faith in Colonial America, realized he must act against outbreaks that routinely devastated Boston. In 1721, his West African slave, Onesmius, told Mather about variolation that had already been practiced for nearly two centuries in West Africa among its vast trade empires. The idea had dated back to China and India from the eleventh century but still eluded European medicine. Mather was convinced and spread the idea through the colonies. Lives began to be saved. Ben Franklin even wrote and distributed pamphlets in the 1750s explaining the process and possible benefits.


In Great Britain in 1796, Dr. Edward Jenner developed a successful smallpox vaccine using cowpox, a milder cousin to smallpox, to gain immunity. In 1799, Dr. Valentine Seaman introduced the smallpox vaccine to the US, gaining a sample from Jenner. In 1802, Seaman organized a free vaccination program for the poor of New York City. In spite of the success of the vaccine, outbreaks still followed; and the public, few of whom understand the ideas behind vaccination, remained unconvinced. As smallpox began to be better understood, state governments began organizing to better train physicians and better organize for epidemics.


In 1837, Texas established the Board of Medical Censors to conduct exams for doctors in order to grant licenses. This model was a first and spread across the US. In 1870, the Quarantine Act gave the governor power to order quarantines during disease outbreaks in port cities, often yellow fever as well as smallpox. In 1879, the governor had the power to appoint a public official for this effort and established the Texas Quarantine Department.


An outbreak in 1898 and 1899 resulted in a violent panic and strict new quarantines to contain it. In late 1898, smallpox appeared in Laredo. With the death of one child, city leaders immediately began investigating the epidemic. More than 100 people were infected by early 1899. Dr. W. T. Blunt was sent by the state to investigate and control the epidemic as the death toll rose. He ordered mandatory vaccinations, quarantines, fumigations of all homes, and the burning of contaminated clothing. Residents were angry at the restrictions and the vaccinations and began resisting. Blunt called in the Texas Rangers in response by early March. The result was the Laredo Smallpox Riot, which sparked gunfights between angry residents and Rangers. The confrontations led to two deaths and a dozen injuries.


The outbreak spread to Galveston, leading city officials to quarantine dozens of residents. The combination of quarantines and vaccinations stemmed the tide. By May 1899, the outbreak had effectively ended. In 1903, the Quarantine Department became the Department of Health and Vital Statistics.


As much as smallpox caused and as much grief as it inflicted upon unsuspecting communities, an answer was ultimately found. Human ingenuity found the key to defeating the ancient pathogen. Massive public health campaigns were launched along with mass vaccinations around the world starting in the 1950s. Infection rates plummeted. The last natural case occurred in 1977, with smallpox declared completely eradicated from the globe by 1979. Science had ultimately made a nightmare become a distant memory.