Discussion Boards on Chemical, Biological and Nuclear Weapons

The War Against Smallpox
David W. Tschanz, MSPH, PhD

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In Atlanta and Moscow, locked inside stainless steel freezers deep in the bowels of the Centers for Disease Control and Prevention and the Moscow Research Institute for Viral Preparation's High Containment Laboratories, is confined the greatest serial killer in the history of mankind. Smallpox, eradicated as a naturally occurring disease in 1977, waits in 500 vials for the determination of its final fate.

The exact origins of smallpox are lost in the mists of pre-recorded history. Most disease historians point to the Indus Valley of India as the place where smallpox made its first appearance. The oldest known case for which proof exists was that of the Egyptian pharaoh Ramses V who died in 1160 BC and on whose mummified remains the classic lesions of smallpox can still be seen. The last naturally occurring case was a young Somali hospital cook who contracted the disease in October 1977. Between pharaoh and cook, smallpox was responsible for the deaths of millions and reshaped currents of history. It was overcome by a ten year campaign that combined all the elements of a military undertaking.

The Enemy

Smallpox's scientific name is variola. Variola major was the only form of smallpox recognized until the Nineteenth Century when a milder strain, variola minor, appeared recognized in southern Africa and the West Indies. This strain later spread to Brazil, North America and parts of Europe. The disease caused by variola minor and its spread was exactly like variola major. But whereas variola major killed 25% of its victims, variola minor killed only 1 percent or less. Variola minor also scarred its victims less frequently (7% vs 75% for variola major). In 1965 Henry Bedson, the eminent British virologists, identified a third strain, variola intermedius, in samples isolated from East and West Africa. All three forms bred true and an attack by one conferred immunity against the others. Variola major predominated until just before the disease was eradicated.

Smallpox's onset was deceptively ordinary. About two weeks after infection, usually by inhaling the virus on airborne droplets, a victim developed a fever and splitting headache, often accompanied by a backache, chills and vomiting. Two or three days later, as these symptoms began to fade, the first sign of the rash appeared, starting on the tongue and palate and spreading rapidly on to the forehead and face and then to the limbs and the trunk. The spots filled with fluid, growing and hardening. The result was painfully disfiguring with swollen pustules sometimes so severe that they forced the victim's eyelids shut. At this point -- 10 to 16 days after onset, death was most likely to occur. In the past it was known that if the sores did not touch (discrete smallpox) mortality was less than 10%, if they ran into each other to form huge pustules, mortality was 50 % (confluent smallpox). If bleeding erupted beneath the surface of the skin, and from the nose and mouth (hemorrhagic smallpox, purpura variolosa, black smallpox) death was certain. If the patient survived this stage there was a gradual subsidence of the symptoms, with scabbing and healing. Frequently it left the victim branded with pockmarks for life.

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Discussion Boards on Chemical, Biological and Nuclear Weapons