Smallpox: Symptoms, History, Facts & More

By Dr. Kyle Smart, DO, Chief Medical Officer

Cucamonga Valley Medical Group



Imagine living in Colonial America and among the many hardships your family had to face, you also had to deal with the looming potential of contracting variola virus, otherwise known as smallpox.

No demographic was spared by this virus as it infected the young and old, male and female, rich and poor, every culture and ethnicity. 

During this time, smallpox was identified by the devastation of the disease.

Smallpox History

The initial spread of smallpox is closely connected to the growth of civilization and was linked to countless illnesses and deaths.

At the time, there was a basic understanding of the disease, but not to the extent of the knowledge that we have today.

After all, microbiology, specifically bacteriology, came to be in the 1600s and the basic understanding of viruses would have to wait until the late 1800s. The study and understanding of the immune system, immunology, began in the late 1700s, in large part due to the research of smallpox.

Many solutions to keep this disease at bay were tried and tested but it wasn’t until the smallpox vaccine was introduced in 1796 that the worldwide impact of smallpox began to decrease.

Thanks to the effectiveness of the vaccine, the last natural smallpox outbreak in the United States took place in 1949, and in 1980 the World Health Assembly announced that smallpox had been eliminated.

In the more than 30 years since this declaration, there haven’t been any reported cases of naturally-occurring smallpox.


Smallpox Symptoms & Information

The symptoms of smallpox were reminiscent of the flu:
  • Body Aches
  • Fatigue
  • Fever (101 – 104 degrees Fahrenheit)
  • Weakness

These symptoms would be followed by a rash, which began in the mouth and throat. The rash, which had disfiguring effects, would spread to the skin and cover people from head to toe, lasting about two weeks.

The most common form of the rash from smallpox was raised bumps or “pox.”

Survivors were left with deep scars in their skin, encompassing their entire body.

It’s hard to imagine, but if you got this type of smallpox it was the one you wanted as the death rate was only 30 percent.

Let that sink in.

At that time, just under one-third of those infected with ordinary variola major would succumb to the disease, as opposed to the other forms of the small pox rash, which were either flat or bleeding (hemorrhagic), where death was almost certain.

Can you imagine smallpox sweeping through your town?

Your friends and family members begin to show signs of the disease. Now, you have to wait to see which rash would show up. As sad as it is, you’d probably pray for pox.


Did you know? Smallpox Facts

The initial spread of smallpox is closely connected to the growth of civilization and was linked to countless illnesses and deaths.

Here are three notable historical figures who were infected or affected by the disease.


Benjamin Franklin

Benjamin Franklin’s four-year-old son died of smallpox.

He wrote, “In 1736 I lost one of my sons, a fine Boy of 4-years old, taken by the smallpox in the common way.”


Andrew Jackson

Andrew Jackson contracted smallpox at the age of 14.  At the time, he and his brother were taken as prisoners of war during the War of Independence when they were both infected with smallpox.


Abraham Lincoln

Abraham Lincoln and his valet contracted smallpox after delivering the Gettysburg Address. Though Lincoln recovered, it was reported that the valet died from the disease.


Smallpox Vaccine

There was a time when variolation was the best solution to slow and stop the spread of smallpox.

In short, variolation was the practice of deliberately infecting someone with smallpox who did not have the disease.  At the time variolation was a solution to the devastation of smallpox by increasing the individual’s chance of survival and overall decreasing the spread of the disease. Variolation is the cradle of vaccination.

At this point in time, one to two percent died from variolation which was in stark contrast to the 30 percent of people who died from contracting smallpox naturally.

Thankfully, we don’t have to make that choice for ourselves or for our children anymore as variolation evolved into inoculation which in turn evolved into modern day vaccination.

The smallpox vaccine helped safely lead to the worldwide eradication of smallpox.  The smallpox vaccine did so without the complications, risks, and lack of precision found in variolation and direct inoculation.

The smallpox vaccine does contain a live virus, rather than a killed or weakened virus that’s typically found in other vaccines.

Note: The smallpox vaccine does not contain the smallpox virus (variola), hence it cannot give you the disease. It contains the vaccinia virus, a less harmful relative of smallpox.

The side effects that are commonly associated with the smallpox vaccine are:


  • Body aches
  • Fever
  • Sore arm


More serious side effects can occur if a person has or has had certain conditions like atopic dermatitis or eczema or have a weakened immune system.


Why is the Smallpox Vaccine Important?

Why end this series of vaccine articles discussing smallpox?  After all, smallpox has been eradicated and is not a threat to humans anymore. It’s important to remember smallpox because it’s easy to forget the devastation of rampant, unchecked diseases.

It’s estimated that hundreds of millions of people died of smallpox. Thankfully, nestled early in the 21st century, we’re far removed from the dangers of smallpox, polio, diphtheria, and other diseases.

We’re standing on the foundation laid by past generations who suffered through these epidemics and collectively advanced science and technology, as if their very lives were at stake, curbing the spread of such diseases and increasing our chance of survival.

Let’s not forget how we got here, how vaccines came to be, and why the current vaccination recommendations and standards exist.

I hope that this broad discussion of vaccines will help people make a more informed decision when choosing to vaccinate or not.