Smallpox

Smallpox, a contagious disease produced by the variola virus (genus Orthopoxvirus), was eradicated in 1977. The word smallpox is believed to come from the Latin word pocca meaning ‘pouch,’ and variola from varius or varus meaning ‘spotted pimple.’ There were three subspecies of variola: variola major, intermedius, and minor. The milder form of the disease, variola minor, had a case-fatality rate of less than 1%, whereas the rate for variola major was 25% to 50%. Ten percent of the smallpox cases involved hemorrhagic smallpox that was quickly fatal.

Smallpox was found only in humans and was usually transmitted through droplet nuclei, dust, and fomites (inanimate objects such as blankets that can transmit germs). The incubation period was between 12 and 14 days, with the respiratory tract as the main site of infection. The prodrome, or early symptom of the development of smallpox, was a distinct febrile illness that occurred 2 to 4 days before eruptive smallpox. Rashes usually developed 2 to 4 days after being infected. The smallpox rash was centrifugal, found more on the head, arms, and legs than on the trunk area of the body. Smallpox was very disfiguring because crusts on the skin would form from the fluid and pusfilled spots on the body. Many who survived smallpox had bad scars on their face or were blinded. Because of the rash that formed in the majority of smallpox cases, surveillance of the disease was less problematic.

Common symptoms of smallpox were fever, headache, backache, malaise, and abdominal pain. The very young and very old were at higher risk of dying of smallpox. Exposure to smallpox usually occurred in either the family or hospital setting. Compared with [Page 979]chickenpox and measles, smallpox was not as infectious. Persons with smallpox were infectious from the time fever arose until the last scab separated; they were not infectious during the incubation period. A patient who survived smallpox was resistant to the infection.

The origin of the smallpox virus is thought to have been 3,000 years ago in India or Egypt. For a very long time, smallpox epidemics were quite common, annihilating populations. Smallpox wreaked havoc on the royal houses of Europe between 1694 and 1774, with Queen Mary II of England, Emperor Joseph I of Austria, King Luis I of Spain, Tsar Peter II of Russia, Queen Ulrike Elenora of Sweden, and King Louis XV of France all dying of the disease. In the 18th century, 1 out of every 10 children born in Sweden and France died from smallpox. Many Native American tribes were annihilated by the smallpox epidemic that occurred around 1837. The Native American tribes were introduced to smallpox through European settlement.

There were a number of ancient practices that were introduced to prevent smallpox. Worshippers could pray to a deity such as the Indian goddess of smallpox, Shitala Mata, or to the Chinese goddess of smallpox, T'ou-Shen Niang-Niang. Roman Catholic Europeans could pray to St. Nicaise, the patron saint of smallpox. There was also a widespread notion that red-colored objects could combat smallpox. The Red Treatment, as it was called, used red objects such as a red cloth hung in a room of smallpox victims in an attempt to prevent smallpox. Another method tried was inoculation of infectious matter from smallpox victims implanted into patients. It was not until 1796 that an English physician by the name of Edward Jenner (1749–1823) discovered a vaccination for smallpox.

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