History of Smallpox - Eurasian Epidemics

Eurasian Epidemics

There are no unequivocal records of smallpox in Europe before the 6th century CE, but it has been suggested that it was a major component of the Plague of Athens that occurred in 430 BCE, during the Peloponnesian Wars, and was described by Thucydides. A recent analysis of the description of clinical features provided by Galen during the Antonine Plague that swept through the Roman Empire and Italy in 165–180, indicate that it was probably caused by smallpox. Although some historians believe that many historical epidemics and pandemics were early outbreaks of smallpox, contemporary records are not detailed enough to make a definite diagnosis. In the 2nd century, returning soldiers brought the disease home with them to Syria and Italy, where it raged for fifteen years and greatly weakened the Roman empire, killing up to one-third of the population in some areas. Total deaths have been estimated at 5 million. A second major outbreak of disease in the Roman Empire, known as the Plague of Cyprian (251–266), was also either smallpox or measles.

Most of the details about the epidemics are lost, probably due to the scarcity of surviving written records from the Early Middle Ages. The first incontrovertible description of smallpox in Western Europe occurred in 581, when Bishop Gregory of Tours provided an eyewitness account describing the characteristic symptoms of smallpox. Waves of epidemics wiped out large rural populations. The establishment of the disease in Europe was of special importance, for this served as the endemic reservoir from which smallpox spread to other parts of the world, as an accompaniment of successive waves of European exploration and colonization.

Around 400 AD, an Indian medical book recorded a disease marked by pustules and boils, saying "the pustules are red, yellow, and white and they are accompanied by burning pain … the skin seems studded with grains of rice." The Indian epidemic was thought to be punishment from a god, and the survivors created a goddess, Sitala, as the anthropomorphic personification of the disease. Smallpox was thus regarded as possession by Sitala. In Hinduism the goddess Sitala both causes and cures high fever, rashes, hot flashes and pustules. All of these are symptoms of smallpox.

The clearest description of smallpox from pre-modern times was given in the 9th century by the Persian physician, Muhammad ibn Zakariya ar-Razi, known in the West as "Rhazes", who was the first to differentiate smallpox from measles and chickenpox in his Kitab fi al-jadari wa-al-hasbah (The Book of Smallpox and Measles).

Smallpox was a leading cause of death in the 18th century. Every seventh child born in Russia died from smallpox. It killed an estimated 400,000 Europeans each year in the 18th century, including five reigning European monarchs. Most people became infected during their lifetimes, and about 30% of people infected with smallpox died from the disease, presenting a severe selection pressure on the resistant survivors.

In northern Japan, Ainu population decreased drastically in the 19th century, due in large part to infectious diseases like smallpox brought by Japanese settlers pouring into Hokkaido.

The Franco-Prussian War triggered a smallpox pandemic of 1870–1875 that claimed 500,000 lives.

In 1849 nearly 13% of all Calcutta deaths were due to smallpox. Between 1868 and 1907, there were approximately 4.7 million deaths from smallpox in India. Between 1926 and 1930, there were 979,738 cases of smallpox with a mortality of 42.3%.