It has been said that a single incidence of smallpox anywhere in the world would constitute an epidemic. Smallpox was eradicated in India, the last strong hold of the disease, in 1974. In D.A. Henderson’s telling work Smallpox- the Death of a Disease: The Inside Story of Eradicating a Worldwide Killer, the author tells the story of the 115,000 volunteers, public health professionals and healthcare workers who bravely ventured in to the many remote villages and communities of India in a successful and concerted effort to squash this deadly disease. Even more engaging, however, is the account of events leading up to this effort which Henderson recounts. Henderson’s background as a physician and public health professional coupled with his history as Director of the Center for Disease Control’s Epidemic Intelligence Service and subsequently as the Director of The Eradication, the World Health Organization’s initiative to end smallpox, lend great credence to this work.

Smallpox is a viral disease which presents as a rash and eventually fluid-filled blisters on the skin roughly two weeks after a person has come into contact with the virus. It is fatal in an estimated 50% of those who contract the disease, with fatality rates being higher in children and the immuno-compromised. Smallpox is highly contagious and quickly spread amongst families. As early as the 10th century, smallpox was combated by the process of variolation. Variolation involved the extraction of pus from the postule of an affected individual and the direct injection of said pus beneath the skin of a healthy individual. Much like modern vaccinations, this process was intended to expose the healthy individual in such a way that he or she might create antibodies to the virus without becoming ill. Unlike modern vaccinations which primarily used inactive strains of a virus, this process utilized a live strain of the virus and thus frequently worked not as a vaccine, but as an exposure point to the virus after which the healthy individual became ill.

Henderson recounts how the much safer, cowpox vaccine, was discovered in 1796. it was after this discovery that vaccinations became mandatory in many states and in the U.S. army. During this same time period, smallpox made its way out of Europe and Asia and into the Americas. Many Europeans had antibodies to smallpox, having contracted it and survived the disease earlier in life. By the time the cowpox vaccine was discovered, however, the Native American population had already suffered greatly from this deadly virus. Because the virus was foreign to the Americas, no Native Americans had antibodies to the disease nor did they have any knowledge of the disease progression ad treatment. Thus, by the time that the thirteen colonies rose up against England, much of the Native American population in what is now the United States had been completely decimated.

Henderson’s account of the only official, successful eradication of a disease in history is a must-read for anyone interested in the world of contagious disease, of preventative medicine and of epidemics.