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Angel of Death: The Story of Smallpox

Michael Worboys enjoys a timely look at the eradication of smallpox

Published: September 20, 2010 at 8:14 am
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Reviewed by: Michael Worboys
Author: Gareth Williams
Publisher: Palgrave Macmillan
Price (RRP): £18.99


This year marks the 30th anniversary of the global eradication of smallpox, which remains the only infectious disease banished by modern medicine. It was achieved by focused campaigns that combined surveillance, vaccination and the isolation of sufferers.

It is then timely for a new history of smallpox and Gareth Williams has produced an engaging narrative, in which medical history is interweaved with social history and reflections on contemporary issues.

The author makes excellent use of letters and other personal papers to record the experiences of victims and their relatives, as well as the stories of the doctors who tried to tame ‘the Great Killer’, as smallpox was known.

Also valuable is the attention given to the technical changes in the methods of vaccination and how the disease was a moving target, because its serious form, Variola major, was displaced across the world in the 20th century by the milder Variola minor, with epidemic waves replaced by endemic persistence.

The author was inspired by a visit to the Jenner Museum in Berkeley, Gloucestershire, which is in the house of Edward Jenner, now acknowledged as the inventor of vaccination.

The story begins with a survey of the ravages of smallpox across civilisations and centuries, the fears it engendered, and the many methods tried to prevent and treat before Jenner. Variolation, an unreliable procedure of giving a mild infection of smallpox to protect against future serious disease, was introduced in the 1750s, paving the way for vaccination. 

Jenner was not the first person to observe the negative association of cowpox with smallpox, but he was the first to investigate the phenomenon, develop methods to exploit it, and promote its use. Williams shows that there was no Eureka moment. Jenner was not a driven medical investigator, rather a convivial country doctor who took up vaccination relatively late in his career.

His methods were immediately controversial in medical circles, where his priority was disputed and their effectiveness questioned.Yet Jenner had more supporters than enemies and his innovation was quickly spread around the world, with adaptations made for different settings.

High profile anti-vaccination campaigns emerged in many countries after 1850 and Williams unhelpfully characterises the controversies that ensued as “a tangled mess of big egos and self-interest, bent statistics, lies and fraud”. This was certainly part of the story, but these features mattered less than genuine medical uncertainties, concerns about the growing powers of the state, and class politics, which Williams actually goes on to detail.

Protests waned as smallpox went into retreat in the 20th century, and when eradication was adopted as a goal in the 1960s, smallpox was only a serious problem in certain third world countries. This is not to say that eradication was easy or inevitable, though smallpox was no longer ‘the Great Killer’ that it had been for much of human history. 


Professor Michael Worboys, University of Manchester


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