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of smallpox and its around the refer readers learning more and its con of smallpox and its around the refer readers learning more and its con

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of smallpox and its around the refer readers learning more and its con - PPT Presentation

mummified head preserved royal mummies mummies museum Inspection of the mummy revealed a rash of elevated 145pustules146 each two to four millimeters diameter that lower face neck and visible on espec ID: 896470

century smallpox population epidemics smallpox century epidemics population time africa occurred china disease north million 148 vaccination spread 147

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1 of smallpox and its around the refer rea
of smallpox and its around the refer readers learning more and its control. attack conferred lifelong immunity on survivors and neither chronic nor recurrent infectivity occurred persistence of endemic state human community was possible population admitted large regular accession of immigration. Where estimates have in the must be estimates are of smallpox, list of this chapter historians have Unmistakable descriptions the 4th India and Mediterranean, and of these the time of disease, potentially more ancient writings, but is very scarce. of civil- in the Trade and region a single concerned. However, apart from caught from the 14th which could conceivably have the written records of these Talmud and any disease largest and densest in the valley of but none been described the Egyptian bones of of royal personages, and diagnoses of several persons have literature mentions looke

2 d like Ferguson (1911) skin showed dome-
d like Ferguson (1911) skin showed dome-shaped Egyptian mummies can sometimes investigators for (1921) mentioned the Eighteenth of Ramses of Ramses diagnosis of smallpox, and in was able mummified head preserved royal mummies mummies museum. Inspection of the mummy revealed a rash of elevated ‘pustules’, each two to four millimeters diameter, that lower face, neck, and visible on especially, these pale yellow brown-reddish background, the cosmetic compounds in royal during that only smaller (one to seen, which wrappings over or soles highly characteristic his arms with the the shroud his soles. or upper abdomen. mummy, published that the lower abdomen and swollen when pustules and apparent distributionof the have seen recent victims.” have expected that an epidemic disease as pharaohs and would have been described medical subjects northern neigh- illness affec

3 ting skin which been smallpox. have occu
ting skin which been smallpox. have occurred over a thousand reliable references to the ancient world. caravan or, by sea. in the rice-growing, developed million lived in the ever since. Holwell (1767), a Calcutta, suggested immemorial”, and stated in the Atharva Veda. suggestions have and Hopkins in India from early times. Nicholas (1981), a scholar and anthropology, in the and Suiruta, and put the 4th Nicholas these little about the history ancient times 15th century 16th century 17th century Smallpox probably Variolatlon by Smallpox epidemlc western Afrlca. smallpox In eastern central Afrlca outbreak In Varlolatlon Introduced into North Colonial army orders variolation Quebec (1776). Presldent Jefferson lnitlates vaccination President Lincoln smallpox (1863). and spreads Oceania Europe smallpox declmates Ethlopian Blshop Marlus carry smallpox invading armles and Spa

4 ln. and measles varlolatlon by In Chlna
ln. and measles varlolatlon by In Chlna lshinho publlshed Gilbertus Angllcus clinical types recommends “red smallpox. Epldemlc Variolatlon introduced epldemics among aborlgines smallpox epldemlc smallpox maintained Sydenham describes clinlcal types Variolatlon introduced Inoculation Hospltal founded Heberden dlstlnguishes smallpox Dlmsdale varlolates Catherlne the Great Smallpox cripples fleet attacking Compulsory vacclnatlon Revacclnatlon proposed Establlshment founded Naples begins in cow Production In introduced In great epldemlc Copeman demonstrates bacterlcldal a trivial skin Vagbhata, a in the Madhava-kara included an extensive chickenpox and have changed its characteristics al-Razi, towards now know However, Chinese descriptions from the only suggestion the Indian subconti- attacked Alexan- Indus, but in the in the populated agricul- disease was in the latter par

5 t the 20th Apart from problematic epidem
t the 20th Apart from problematic epidemic referred to, earliest reference an epidemic been smallpox of Mecca (Moore, 1815). soldiers were severe illness almost totally destroyed Egyptian Mediterranean produced notable works a Christian priest “When the time, the eruption moderates, good hopes Zakariya, al-Razi measles was Latin and Greek the 17th Besides clearly Hung in Razi made some incidence (most spring) and that it disease of Persian scholar, During the populated part Christian era had shifted unequivocal records the 6th that it Athens” that during the “Ethiopia” and before crossing and thence reaching Athens. smallpox whose descriptions are China, Vagbhata Asia Minor-describe primarily a disease of factors. Alivizatos extensive epidemics only century, eventually becoming a given the only at change occurred more rapidly populated countries (for Mexi

6 co, see in the concerned (for in south-w
co, see in the concerned (for in south-western Except for absence of any reference pockmarks in those from gaining control of Sicily, siege of Syracuse may also in Europe the Antonine a Roman army fighting greatly weakened Roman empire. Galen, and, more recently, (1973) argue in the Antonine Apart from were few population in various epidemics from the onwards have been ascribed disease. St the Huns in later accepted the patron the 6th have occurred Tours, but 5) considers this outbreak this time Bishop Marius (near present-day a pimple) 5 centuries later we call in the 7th and Portugal with their warriors crushed may also from time from endemic half of the 10th the Arab-controlled China and in the valley of million people in the in the and Yangtse political unification population grew around that rice-growing potential very early and India, country. According in the people h

7 ave short time first appeared the fourth
ave short time first appeared the fourth then spreading the Chien- point out accurate dates they conclude that the smallpox was in the aboriginal tribal people Following Hirsch introduction than north in in the populated river century onwards pockmarked persons of sparsely total population islands were the 6th cultural and were increasing China and Korea. Buddhism was first Japan from Korea were made introduced at about same time, centuries. Nara, first real 710; in city of half a tants and bronze statue during the 10th were still Spread of to do have developed irrigated agriculture perhaps some years ago. doubtful hon- Egypt and made periodic incursions Mediterranean littoral until the into the Iberian Peninsula in the size increased various parts known throughout Al-Razi published his percipient account era smallpox east, first and later Burma Road in the the north. probab

8 ly already the 4th tiated between before
ly already the 4th tiated between before al-Razi. Subsequently, were developed China and Korea and Japan, latter countries, endemic there the 10th the 10th century, therefore, in the populated parts Eurasian land and along were still many but the was set for endemicity explosive epidemics, when this inhabited world. throughout the up to of 25 in the valley of Indian subcontinent steadily over succeeding somewhat more exploded, exceeding 280 India for over 2000 Apart from the Hindu historical evidence after 1500, aspects of ecological and (spring) epi- was observed 1500 had probably prevailed pox came where 8000 children Inoculation, Variolation and Vaccination into the of susceptible was called cowpox lesions became necessary was used “vaccination” and book we and variolation reserving “vaccination” for procedures vaccinia virus. was always scabs of After

9 animal during the latter part “lymp
animal during the latter part “lymph” from arm-to-arm vaccination shipped over long being dried Saints Associated with Smallpox demonstrates its impact with the describes these deities the Huns had recovered of smallpox, became during the (which threatened mainly a neglect of St folk goddess early times, whose smallpox dates later period (Nicholas, from about century onwards Sitalii was closely associated a widely temples and all over changes occur now that a goddess during the mid-19th century most popular worship among were erected over China. century hero a smallpox in the of smallpox red had an ancient and persistent a smallpox south-west Nigeria, Benin introduced from century. Formal variolation. Sometimesjticheurs were suspected of took Sopona the Earth”) in the and deaths infants and young members of poses of they had smallpox. Facial responsible, was a

10 steady succession of major great epidem
steady succession of major great epidemic of 1883-1884 level, because increasing vaccination many parts until the India and countries to it achieved there. between India (Thailand) and Indochina sent-day Democratic Kampuchea, Lao Peo- Democratic Republic are rather although until 1900 of Siam the other numbered about had doubled 1000 and smallpox created a deep population, and distinct situations in which such epidemics occurred previously, or at for many segment, perhaps illness of most subsistence society, such epidemics were disease finally lack of epidemics some encountered populations susceptible persons composed children or immigrants. were recorded Europe in reasons-demographic, climatic susceptible persons and for transmission fluctuated exacerbations occurred every few latter situation severe, because 3 countries million, and growth then countries prior to the cent

11 ury. A of smallpox military campaign 136
ury. A of smallpox military campaign 1368, and 1785 from statistics are Public Health was probably during the 14th century onwards are repeated formal and words for 1987). These French writer but the this Country it often without burning them” - - 1890 1900 of primary 1875 onwards. Epidemic peaks occurred about (Data from of vaccine ITS SPREAD AROUND being sent from and Indochina during the among chil- some epidemics have a prolonged nubile women. pockmarked and of all Indian subcontinent and Eurasian land variously described and the Middle East. comprises present-day Afghanistan, Iraq its Mediterranean and Turkey-in-Asia. However, Turkey, supported populations million for previous 2 millennia, and they during the corridor for trade, culture and conquest between Persian scholars, from at the 6th armies began most persons would have several of rulers of Arabian empire, c

12 aliph, leaving and blinding Arab traders
aliph, leaving and blinding Arab traders extended east coast of western Africa, expeditions introduced early times. is said Lady Mary Montagu and procedure in in the community, although beauty of had re- mained at million for valley was Then in killed some Thereafter population the 17th conquest, and total number had reached Smallpox spread the Huang endemic and epidemic in China and Korea. the 4th smallpox were published by Ch’ien smallpox (a characters for “lentil- bean” and this time Niang-Niang (Plate 5.4A), began. was feared preventive inoculation (variola- this time rite and a public practice during the first half of the 16th 1980), but widely used. century China had a population million, and was established disease, affecting was seen the north. Mongols, for time, regarded with the a grave danger, at horse centuries later leaders of dreaded smallpox. in

13 the had had sent on would have go throu
the had had sent on would have go through in which later established, Manchus and Mongols from otherwise mandatory appear- (see box). chus, they did not Shun-Chih Emperor, Ai- son, the 5.3C), was successor precisely because he had smallpox China from 1661 1974). Unlike had his regular against smallpox Late in the Dalai long time because of fear of few weeks his arrival. From this time onwards, later, vaccination but towards century European persons blinded smallpox were still was first adopted and only in China during the half of century. Indeed, vaccination in China was first had reached approximately 3 million. million in 1600 and about in population century and after 1850, when Japan shipping and the population had reached Smallpox had Japan from China ever since the 10th century, with epidemics recorded in the years 915, 947, 974, 993 and Japanese medical book. later spr

14 ead around the world and Europe and the
ead around the world and Europe and the down to also makes special isolation Inoculation Hospital During the widely spaced and 1454). epidemics were recorded the 16th century (1522 and 1550), but the country which the was affected. island of recorded an average the 17th At the end the 17th (variola),fustrka (measles), pox) and introduced from China in its population Customs of Mongols, as hereon, Mongols from the Inner Inner Inner Mongolia] and from the Qalqas who are to inherit a rank, and have (legal) age [18 years], if they have once contracted smallpox, shall presented at smallpox, shall proceed proceed = Jehol, north of the Great Wall] to be installed, appear at court, and several unsuccessful attempts, vaccination 1849, using crusts from vaccination Indies. Between 1850 and 1860, Japan, and Smallpox epidemics tinued, however, A new a compulsory vaccination was availabl

15 e statistics gathered cities. Suda 983)
e statistics gathered cities. Suda 983) have fascinating account of smallpox rural Japan in the epidemic occurred small island (85.7% morbidity) compute the the mountainous Hida 1771 and 1851. endemic in neither variolation nor vaccination total mortality in population and children under 5 subsequent increase in the with the children under years of age, about 11 population but suffered well deaths from rose slowly 2677 (calculated) 3127 (calculated) 5.3. The Hida district in 1771 indicates deaths higher percentage figures) indicates deaths due children under group rose Red Treatment first book mention the of red cloth hangings in the in the doctor reported Japanese physicians think it cloth. When falls sick room and are furnished all persons be clad colour” (Kaempfer, 1906). Red paper around the beds of western Africa, Yoruba god smallpox, Sopona, was associated with th

16 e European countries the from the France
e European countries the from the France (reigned was dressed stockings and a red veil. Elizabeth I were applied other European that the of smallpox developed rules governing erythrotherapy (Finsen, 1901). into the (1904), Schamberg and others had declared it to ago rice-growing million. Wet rice introduced from India in the 4th 1000 and 8 million in the from about islands were even populated initially, only a over a during the 17th islands were Christian Span- from Indonesia. population grew 1800 and 8 million Because of between India and larger islands Archipelago from onwards, there were repeated population concentrations pines were in frequent contact but their Philippines and Indonesia are available Portuguese and in the disease was then known in endemic only far away, ship from carried smallpox Philippines late epidemics were in Sumatra island of following century. viru

17 s arrived in from Mauri- from 181 6 Howe
s arrived in from Mauri- from 181 6 However, supplies often failed because A central Jakarta at Further north, Singapore shortly after Because of India and China, Singapore, while maintain endemic was subject repeated epidemics notable outbreaks EUROPE BETWEEN Smallpox had in Europe epidemic following 1st millennium which time not in central and European Christians and from in the spread smallpox unambiguous” statements about in Europe time (Hirsch, 1883). Some were recorded 20 000 its total population epidemics in 1257 and north-west, from a million in the beginning increase steadily with the breaks of The 18th saw very rapid population 250 million the 15th endemic in disease of good mortality for Italy and they give little prominence smallpox (Carmichael, 1983). Perhaps in the 20th the outlying Iceland and occasionally suffered numerous deaths a “new” which

18 the distinguish it from primary and tert
the distinguish it from primary and tertiary the notion that it whereas smallpox was largely disease of the 16th was well established over most of possibly Russia, epidemics oc- curred more and more frequently, royal houses of France and Fracastoro’s classic He noted could spread disease of al-Razi 600 presence of smallpox New World. a period turmoil in constant military activity, intellectual activities emies were established published. Smallpox continent’s fore- confluent and discrete smallpox A pandemic Near East probably responsible English and French soon carried previously unexposed I600 I620 I640 I660 I680 London, from from Guy Statistical Review important innovation this time death, and from “Bills of in Lon- Geneva had started 1580 (Perrenoud, 1980), and this time is well greater devastation occurred lation and royalty alike. Bills of Mortality, incom

19 plete epidemics occurred in 171 and 1723
plete epidemics occurred in 171 and 1723, and in the England, Emperor Luis I of Russia, doubtless influenced protective inoculation (variola- the Netherlands its popularity pox was common and France, Italy, Spain and Sweden, all of experienced severe however, Catherine commissioned an inoculate her and thus still suffering from recurrent the latter Hopkins (1 During the smallpox killed London, and an and nearly in that British towns, 9 smallpox were was always Britain’s densely large cities, even epidemics, whereas in the populated countryside appeared only epidemics, separated several years. adults from most serious still very Sweden, major and 1784 alone. Rosen Swedish physician, of all Sir Alexander of all each year. born in Berlin recorded each of about 1000 inhabitants. in Weimar to the Vienna, over persons were about 1500 died. Iceland had epidemics and 1786. Jenn

20 er’s discovery and Ire- Russia) was
er’s discovery and Ire- Russia) was losing over each year also was of all of his discovery cowpox virus remarkable speed, sharp con- that it and remained first few decades of Such epidemics extensive vaccination deaths from from about in Den- and 181 Nevertheless, an 8 million smallpox pandemics resurgence were complex. At involving arm-to-arm inoculation, and, lower incidence vaccination declined. reason was give lifelong until 1858 and population much than that. of 1870-1871 was associated poorly vaccinated civilians 800 000 men, revaccinated every 5.4y0, whereas expected, smallpox spread beyond belligerent states least half enforce vaccination Europe, but violent antivaccination personal liberty. smallpox still endemic in Europe, but more hope for because of health infrastructure. Up to and western and the Japan, and Arab traders and slave-traders had tal areas of we

21 stern Africa, but and southern probably
stern Africa, but and southern probably free rations and Americas, Africa 15th-18th centuries opened entire continents advanced technologies and of Europe. conquests owed peoples, especially the pattern Subsequent sections this chapter on the and Australia. Americas, South known whether the among Australian aborigines in caused by from Great inhabited now, far smaller area of rain forests Niger and originated in western Africa, central and eastern Africa central and western Africa were reduced in the numbered about north the presumptive evi- in the mummies, over swept along great expansion century, and Apart from areas of western Africa near tries developed in the the conti- in the central uplands and south Zimbabwe. Commerce Egypt and north-eastern countries (present-day Kenya) and from ancient earliest records have been smallpox this chapter, the “Elephant besieged Me

22 cca were decimated Arab colonies eastern
cca were decimated Arab colonies eastern African India and China, towns, perhaps Portuguese traders Arab merchants. the interior, Kilwa and young children. populous countries Mediterranean littoral strengthened and populated western African kingdoms from century onwards, but there western Africa disease was have been and a established member of some tribes probably been many years in the provided excellent tions for spreading since raiders penetrated deep the interior the caravans carried records exist these incursions, plorers recorded every caravan route. Those were liable while awaiting ship, and in the during the 17th in the east coast, also, slave carried small- settlement at in 1484, and duced smallpox shortly after that. Over free of smallpox Town in this time the only indigenous were Bushmen and the Ban- within the African continent. Maghreb during the in the during

23 the 12th centuries. in western the Portu
the 12th centuries. in western the Portuguese occupation in 16th centuries. the Americas. eastern coast, in southern Africa tions in Ceylon. The probably smallpox-free were already migrating southward from Although there ensuing outbreak suffered severely, nearly every family affected. Many the Dutch because of ing their the Hottentots totally susceptible, died, whole being wiped endemic, however, followed an although the suffered severely, 1000 deaths between the Hottentots were even the Hottentots Kalahari desert, and wiped outbreak occurred from Europe. European settlers value of but the remnants tots and much more Although the from the wards, Arab eastern Africa carried smallpox 1812, and ships intercepted smallpox again Cape Colony, starting another east coast Africa. Smallpox was Although there hunters, the smallpox almost some tribes Africa was eastern Zaire river add

24 ition, 6 were recorded the 19th 1865-186
ition, 6 were recorded the 19th 1865-1866, 1878-1879, 1885-1887 1889-1 890. western Africa, military campaigns, the 19th Angola, an started in 1864 Angolan population, killing over and helped balance of population towards the south. in the famous explorers result of this epidemic in . . entire populations from their people died of wax, and copper, indeed heaps at Variolation antedated the mid-18th century parts it out the inoculations, stood Africa (see Americas were migrants from land (ice) Bering Strait years ago. Before ed” America these people and South del Fuego. total population 1000 and embraced an estimated somewhat more Cuzco were populations. Along in southern America, Venezuela, Colombia and northern to the were about and empty tropical jungles wastes of southern Argentina large populations, city-dwellers were free into North French, its impact episodes diffe

25 red Spanish and in the Western Hemispher
red Spanish and in the Western Hemisphere on the 1507, following exterminated whole died out. Most subsequent African slave trade, in the spread rapidly to the killing about Smallpox spread in 151 where over native population succumbed his followers the Governor under Narviez Narvhez landed near present-day was described Spanish friar, time that Captain Panfilo in this country, there his ships negro stricken had never this time people, and when pestilence among them throughout the Agricultural development the Americas at the time provinces more others the proportion Indians did not know and were very when suffering from smallpox, they died in heaps, like bedbugs. once, they not care for bread or many places happened that everyone in house died, was impossib!e great number dead, they over them in order dead bodies Indians ‘the great leprosy’ because it in some indivi

26 duals death, for they left covered From
duals death, for they left covered From the shortly after followed was cata- Spaniards were (from child- which country Moors had in the at 25 million least half of Guatemala and Yucatan, and greatly the south, Spaniards decided these could smallpox reached 1524-1 527, 6 million inhabitants. Just devastation, from subsequent Spanish that the emperor and designated heir disastrous civil These events Pizarro and his small band entered Cuzco islands, Mexico, America and 2 million have died. Colombia Venezuela were with the disastrous conse- Spanish soldiers this time were many been exposed Papal decree, divided between principal Portuguese 1555, followed and along interior and was said subsequently wave wave of the native in the Mexico and was spared-not the interior were exposed 1660, after had established missions had been assembled, from Portugal, extensively practised. Small

27 pox an endemic epidemics every few years
pox an endemic epidemics every few years. before vacci- in that during the While protect- those inoculated, early years of struggles for America. Brazil its independence from Portugal 1822, and Spanish rule Spanish colony. were made Jenner’s vaccine, 1806, ordered of Spain However, small- throughout the 19th an endemic in the profound demographic native populations virtually wiped Amerindian populations Inca empires are of and South vast area Amerindians, living hunter-gatherers, and practising agriculture along almost a Caribbean, Mexico and South east coast the Nether- Smallpox followed killing many Massachusetts coast, from Plymouth in smallpox followed, immunity and way of life was Some colonists, childhood infection, Americans (Stearn Stearn, 1945). spread were ensnaring them did, with America occurred beyond deadly epidemics decade, smallpox, most fatal forth thro

28 ugh the rence-Great Lakes smallpox destr
ugh the rence-Great Lakes smallpox destroyed and in nearly half Piegan tribe killed half its members. they were taken States jurisdiction Louisiana Purchase, killing two-thirds Omahas and Missouri River and Columbia River erasing perhaps plains and destroyed gines there.” settlers were At this time a decade towns in epidemics occurred have accumulated within the disease usually ship at from Great Britain or, 1659, 1666, York, Jamestown causing substantial those born it disrupted infected persons aboard. 1647, probably yellow fever, 1670 onwards spreading from and among HISTORY OF SMALLPOX AROUND THE Smallpox and Educational Institutions a French . . visited William 1702, he wealthy parents England now intellectual crudities more Virginians would an English afraid of proves fatal them’.” (Boorstin, had been else refused Atlantic. Indeed, risk of in the latter p

29 art the 17th and military activity inter
art the 17th and military activity interacted the Atlantic more frequent outbreaks more a quarter occurred in New York, Phila- epidemics many England and the South, the Indians the white moved westwards which the few of were probably tained in correspondence between Sir Amherst, Commander-in-Chief the time send smallpox some blankets may fall and take smallpox had Mountains with them, reported in Mexico had been invaded because of but often proved new element, variolation, entered gle against smallpox the situation among the whites not the year saw Boston’s was less scale (see this latter of Boston’s 684 residents 5545 of had already had smallpox susceptible persons (Blake, 1959). smallpox broke 1792, practically and only 69 deaths from naturally acquired smallpox the now in the ary Wars, General Washington being anxious about the Continental the long dura- siege of

30 Boston-from large degree in the fear of
Boston-from large degree in the fear of and exposing ordered “one thousand had had possession of in that region and 1777 Wash- compulsory variolation new recruits a historian (Thursfield, . . properly controlled applica- years 1775-76 cause, was in the few years soon after at Harvard 1799 and Despite imperfect vaccine, widespread white population during the in the epidemics, Boston 6 and Baltimore plies of lack of for revaccination, population, but devastating pandemics many tribes population over the North west of terrible epidemics Federal decision the survi- second half of century the Indians than the white and America, many the non-Indian population, among widespread epidemics, 1865-1866, 1871-1875, when regiments Civil War in the were 6716 deaths among troops and among the 431 237 dent Lincoln probably febrile he gave on 19 rash appeared had been made illegal 1807

31 and in the Civil War with it the furthe
and in the Civil War with it the further importations Washington, Cincinnati, New York, Boston and series of outbreaks occurred in early 1880s, time the throughout the the 19th appearance and Canada and Chapter 8 embrace Australia and Papua New Guinea. “Great South the Northern Hemisphere, had explorers had made first voyage of James Cook he charted east coast other distant comprising 11 ships carrying guards and 4 August and arrived until the that the aborigines had for at severe smallpox Britain, mitigated somewhat that the East Indies, were fact they hunter-gatherers who, Americans, were free the common However, in 1789, have spread and wide commentators (Cump- 1983, 1985). but one seaman suffered determined, but ties have been canvassed. Although there used, lost the other area of very rare had been introduced along the north coast of contact between and whites, ex

32 cept near Sydney, this, and smallpox app
cept near Sydney, this, and smallpox appears indigenous popula- of smallpox occurred the north coast across about 1861 originated from the voyages of the north the 1789 1829 outbreaks and suggests an important great decline south-eastern Aus- in the first half subsequent history has been great detail Europeans occurred from a hailing from Liverpool, England. 4 deaths among the 16 colonies before the 19th one or two but their source could in New with 154 occurring over for strict would have 91 4) Australian ports between and 1900, acquired smallpox many different ago and Europeans in immigrant ship but quarantine further mention 2 ships arrived Auckland. Between ships arrived but extension occurred only (Maclean, 1964). never endemic Papua New outbreaks occurred and shortly European settlement. pockmarked natives north-west and manv died (Kaiser Wilhelmsland) in June treated

33 “thousands entirely prevent program
“thousands entirely prevent program which profound hostility both parties Pacific Islands measles was 1875 and smallpox never occurred there, of labourers from India. the training Pacific islands is said epidemic occurred in the in Guam time, and indigenous inhabitants 8 months. had been forcibly removed effects of tuberculosis reduced the population there for endemic in for a few years was first disease first Florida in 1896 However, recent investiga- in the Chapter 2) have been two in (Brown, 1896 how the and central independent origin eastern Africa. his descrip- eastern Africa, state: “There milder form chickenpox of the end eastern Africa, of variola appearance and SPREAD AROUND the world, within Africa. brackets indicate importations that in the the routes present in South often together variola major, in southern, eastern central Africa the Mediterranean to

34 North Italy in Africa. There independent
North Italy in Africa. There independent, focus somewhere in eastern Africa. half of the 20th although this global spread In the the country and from Philippines (Fig. those countries. Brazil after eventually eliminated from much more because of lack of reliable records that continent. probably spread to North during the Sudan, Tanganyika countries (present-day the 20th tury, at mic variola disease was only endemic form periodic outbreaks variola major of Africa smallpox occurred in the periodically causing variety of smallpox when the Intensified Smallpox commenced opera- but there information about when variola major smallpox are most early it are earliest credible evidence in the years ago. transferred from China from the 6th from China smallpox made periodic incursions but did during the and more populous disease affecting steadily increased, and morbidity and mortality

35 India and China. in Europe of special im
India and China. in Europe of special importance, for this smallpox spread European exploration island of native Amerindians in the and the east coast of America occurred about a was also dians, and subsequently mid-18th century Australia and 1789 and 1829 and tion among the American colonies, somewhat mitigated among the during the latter part century, but its incidence was widely used and the practice of revaccination ravages of in Europe it remained almost unchecked much milder form of smallpox, variola countries and variola major, in varying “Plagues” are in ancient may have the principal descriptions before the 1545. Scattered ences occur smallpox accom- panying military campaigns more complete century, after British rule decade later, 767) described situation in remained character- with spring season) maxima, epidemic intensity and a particularly severe of sm

36 allpox Bengal in 1769-1770. had been but
allpox Bengal in 1769-1770. had been but its from inoculated Jean de in sending Bombay, via a British trick, vaccination initially more rapidly India. However, take its example, superimposed during the first half 1844 and During the the 19th compiled which al- causes of in India. For in British deaths from smallpox were Many of India, up were intensified religious festivals, AROUND THE 223 Sopona, smallpox god who were 222 SMALLPOX AND ITS ERADICATION T'ou-Shen Niang-Niang, 4 I P SPREAD AROUND THE 221 P L 5 IZ in Mexico in the in the ibliothkque nationale, Paris. C: K’ang Hsi, emperor after century portrait.) Z 5 4 5 f s 3 Although the x Smallpox before antiquity until in southern Indian subcontinent and Indochina China and Korea Indonesia and 1000 and Papua New appearance and from antiquity myths and a brief characteristic clinical dramatic and di