Before the advent of modern medicine, smallpox was a devastating disease. It killed about three out of every ten people who contracted it. It also left survivors gruesomely scarred. Variolation had been practiced for quite some time in Asia, Africa, and the Middle East, but 18th-century Europe was resistant to jump on the bandwagon. This was despite huge outbreaks that killed hundreds of thousands of people, including a few reigning monarchs.