Smallpox
Smallpox, the most universally feared of all diseases
during recent centuries, is now a vaccine preventable
disease of historical interest only, its global eradication
having been certified in 1980. Before vaccination was
practiced, almost everyone eventually contracted the disease.
Better sanitation and improved economic conditions had
little influence on the incidence of the disease. Smallpox
could occur and spread in any country, and case fatality
rates were little altered by therapy. Case fatality rates
of 20% or higher were associated with outbreaks of variola
major, the only known variety until the end of the 19th
century. Most of those who survived had distinctive residual
facial pock marks, and some were blind. A second variety,
variola minor, became the more prevalent variety throughout
the United States in the early 1900's, producing less
severe illness and associated with case fatality rates
of 1% or lower.
In 1796, Edward Jenner demonstrated that a person inoculated
and infected with cowpox was protected against smallpox.
Smallpox vaccination in the United States began four years
later, but its routine widespread use did not commence
until early this century. In 1905, the U. S. Supreme Court
unanimously upheld the legality of a Massachusetts statute
which empowered local boards of health to require vaccination
against smallpox of all residents. Reported cases of smallpox
in the U. S. declined from 102,791 in 1921 to 5,000 to
15,000 cases annually between 1932 and 1939. The first
year for which data on smallpox in Maryland could be found
in the EDCP files was 1910. In 1914, 541 cases were reported,
the largest number ever reported in the state. Between
179 and 229 cases were reported in Maryland each year
from 1918 to 1921, but only one case was reported after
1931. This last reported case of smallpox in Maryland
occurred in 1943, and the last documented case in the
nation in 1949. Routine vaccination in the U. S. continued
until 1971 in case smallpox was imported, and was enforced
in most states through school entry requirements.
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