Smallpox

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Smallpox is an infection caused by the virus called variola (pronounced vuh-RY-uh-luh). Throughout history, smallpox has been a greatly feared disease. It has been responsible for huge epidemics worldwide. The disease has caused great suffering and many deaths. Smallpox is now thought to have been eliminated from the Earth. In 1980 the World Health Organization (WHO) announced that the disease had been wiped out by a bold program of vaccination.

The smallpox virus infected humans only. It did not infect other animals or insects. Neither could animals or insects transmit the virus from one human to another. The disease could be transmitted only by contact between humans. Sometimes a person came into contact with someone with skin lesions caused by the disease. Skin lesions are wounds produced by the virus. They were known as pox. A person also could catch the virus even if the infected person had no lesions.

Smallpox was a relatively contagious disease. The virus could be transferred from one person to another in a number of ways. A person could catch the virus by touching the lesions of an infected person. The virus could also be transferred in droplets of moisture produced during coughing or sneezing. And a person could get the virus from books, blankets, utensils, or other objects used by someone with the disease.

The virus usually entered the body through the respiratory (breathing) tract. It then passed through an incubation period of twelve to fourteen days. An incubation period is the time that passes after a person is infected before symptoms appear. During this time, the virus was multiplying within the body and moving through the bloodstream.

The first symptoms of smallpox were fever and chills, muscle aches, and a flat, reddish-purple rash on the chest, abdomen, and back. These symptoms lasted for about three days. Then the rash faded and the fever dropped.

A day or two later, the fever would return. A bumpy rash would begin to appear on the feet, hands, and face. The rash then spread to the chest, abdomen, and back. The individual bumps in the rash filled with clear fluid. They eventually became filled with pus over a period of ten to twelve days. The bumps (pox) would eventually form scabs. When the scabs fell off, a small pit was left on the skin. People who survived a smallpox infection were often terribly scarred in this way.

Death from smallpox was usually caused by complications. For example, bacteria could easily get into the open skin lesions. Pneumonia, bone infections, or other diseases would result.

An especially severe form of smallpox was called sledgehammer smallpox. The name came from the fact that the infection struck very quickly and with great force. It caused massive, uncontrolled bleeding from the skin lesions, the mouth, nose, and other areas of the body. A person could die very quickly from sledgehammer smallpox.

Throughout history, people have been terrified by smallpox. One reason for their concern was the ease with which the disease spread through whole communities. The other reasons for worry was that no cure for the disease was ever found.

At one time, most doctors could diagnose smallpox simply by examining a patient. The skin lesions had a very characteristic appearance. Doctors also knew what to look for when there was a smallpox epidemic in an area. In modern times, diagnosis could also be made by a blood test. A sample of the patient's blood could be examined under an electron microscope. An electron microscope is a very powerful type of microscope. The variola virus can actually be seen in the blood with this type of microscope.

No cure for smallpox was ever found. The best that could be done was to keep a patient comfortable and wait for the disease to die off on its own.

Death from smallpox ranged as high as 35 percent of those who were infected. In the case of sledgehammer smallpox, the death rate was nearly 100 percent. Patients who recovered from the disease almost always had severe scarring from skin lesions.

A person who has had smallpox can never have the disease again. This fact was known as far back in history as the tenth century. Medical workers in China, India, and the Americas made use of this information. They often tried to protect people from smallpox with a simple form of vaccination. First, they removed the liquid material from the rash of a person infected with smallpox. Then, they would make small scratches in the arm of the person to be vaccinated and place the liquid material from the infected person into the scratch.

This method had mixed results. Under the best circumstances, people who received this treatment developed a mild case of smallpox. They were then protected against the disease for the rest of their lives. However, the vaccinated person sometimes developed a full-blown case of smallpox. Instead of receiving protection from the disease, they would become ill from it.

In 1798 the English scientist Edward Jenner developed a variation on this procedure. He noticed that milkmaids sometimes caught a mild form of smallpox called cowpox. Cowpox was caused by a virus similar to, but less damaging than, the variola virus. Jenner used fluid from cowpox lesions to vaccinate people against smallpox. The cowpox fluid was much more likely to cause mild symptoms of the disease. But it still provided a person with protection against smallpox.

By the twentieth century a very effective smallpox vaccine was available. A vaccine (pronounced vak-SEEN) is a substance that causes the body's immune

system to build up resistance to a particular disease. Most young children in developed nations were routinely vaccinated against the disease and smallpox began to die out in some parts of the world. But it was still common in developing nations.

In 1967 WHO began a campaign to eliminate the variola virus completely. The organization watched carefully for outbreaks of smallpox throughout the world. When those outbreaks occurred, WHO workers were sent to the area where an epidemic was beginning. Everyone in the area was then vaccinated against the disease.

The program eventually worked. By 1980 WHO was able to announce that the disease no longer existed anywhere in the world. Today, samples of the variola virus exist in two research laboratories, one in Atlanta, Georgia, and one in Moscow, Russia. These samples are being saved for research purpose only. Some people worry that a relative of the variola virus may develop that can cause a smallpox-like infection. The variola samples might then be useful in developing a vaccine against the new infection.

Epidemic:

An outbreak of a disease that spreads over a wide area in a relatively short period of time.

Lesion:

A change in the structure or appearance of a part of the body as the result of an injury or infection.

Vaccine:

A substance that causes the body's immune system to build up resistance to a particular disease.

Variola:

The virus that causes small pox. The only two small samples of variola that remain on Earth are being stored in two separate research laboratories.

Smallpox has been eliminated as a human disease. But the virus has not. Two samples remain in scientific laboratories. They have been kept for the purpose of research. Has the time now come to destroy these last two samples of variola virus also?

The World Health Organization (WHO) thinks so. WHO is an international agency that deals with health problems throughout the world. It recommended in March 1986, December 1990, and September 1994 that the virus samples in Atlanta and Moscow be destroyed. The organization was worried that the virus might fall into the hands of terrorists. It could be used to reintroduce the world's most terrible infectious disease to human populations. That risk is too great, WHO believes.

Other scientists disagree. We should not intentionally eliminate any organism, they say, even one as terrible as variola. Besides, we can learn about other viruses by continuing to study the smallpox virus.

In the summer of 1999 the World Health Organization decided to delay destruction of the remaining samples of the smallpox virus until 2003.

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Stoffman, Phyllis. The Family Guide to Preventing and Treating 100 Infectious Diseases. New York: John Wiley and Sons, 1995.

Siebert, Charles. "Smallpox is Dead: Long Live Smallpox." New York Times Magazine (August 21, 1994): pp. 30+.

Wagner, Betsy. "Smallpox is Now a Hostage in the Lab." Washington Post (January 4, 1997): pp. WH8+.

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