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Smallpox: The Disease

Introduction


[Smallpox] is so generally known that a minute description of it is unnecessary.
Very few escape it at one time of life or another.

William Buchan MD, FRCP (Edin), 1789

Endemic or epidemic smallpox was described as variola major (case-fatality rates of 5%-25% or more) or variola minor (case-fatality rates of 1% or less). Prognostic classifications included discrete smallpox (perhaps 60% of all cases). Pocks were separated by areas of clear skin and the case fatality rate was generally 10% or less. In semiconfluent and confluent smallpox (perhaps 30% of all cases), the pustules were so close together that they merged; the case fatality rate ranged from about 30%-60%. Flat and haemorrhagic smallpox occurred in up to 10% of cases and were almost invariably fatal. In flat smallpox, pocks were confluent and flattened. Haemorrhagic smallpox was characterized by widespread haemorrhages into the skin and mucous membranes.

For more information, see:

  • Smallpox and Its Eradication (Fenner et al, WHO, 1988), Chapter 1
  • Smallpox (Rao AR, Bombay: Kothari Book Depot, 1972)
  • The diagnosis of smallpox (Ricketts TF, London: Cassell, 1908)


Laboratory Diagnosis

See:

Role of the Laboratory

* Cited in Smallpox and its Eradication, Fenner et al, WHO 1988

Year Title Authors Source URL
1968 The development of smallpox laboratory diagnostic services
Meeting of WHO Regional Advisers on Smallpox Eradication. Rio de Janeiro, Brazil, 3-10 Apr 1968
DA Henderson personal papers DAH: Chesney Med Arch
1972 The role of the diagnostic laboratory
WHO Inter-Country Seminar on Surveillance in Smallpox Eradication. New Delhi, India, 30 Oct - 2 Nov 1972
Henderson DA SE/WP/72(6) WHO: 10665/68084
1978 Role of laboratory diagnosis in the smallpox eradication programme in India, Jan-Mar 1978 Jezek Z, Basu PN, Sehgal S, Balasubramaniam S, Arya ZS Indian J Public Health 1978 22(1):113-9
1979 Smallpox Surveillance Report #146, Mar 16 1979
Collection and testing of specimens
WHO Smallpox unit WER 1979 54(11):85 WHO: 10665/222400
1982 Laboratory diagnosis of smallpox: role of the Virus Reference Laboratory, Colindale, 1947-70 Macrae AD J Hyg (Lond) 1982 89(3):399-407 DOI: 10.1017/s0022172400070972
PMC: PMC2134242
2002 Diagnosis and management of smallpox Breman JG, Henderson DA N Engl J Med 2002 346(17):1300-8 DOI: 10.1056/NEJMra020025

Epidemiology


Mode of Transmission

* Cited in Smallpox and its Eradication, Fenner et al, WHO 1988

Year Title Authors Source URL
1946 The size and the duration of air-carriage of respiratory droplets and droplet-nuclei Duguid JP J Hyg (Lond) 1946 44(6): 471-9 DOI: 10.1017/s0022172400019288
PMC: PMC2234804
1947 Survival of variola virus in dried exudate and crusts from smallpox patients Downie AW, Dumbell KR Lancet 1947 249(6452): 550-3 DOI: 10.1016/s0140-6736(47)91671-1
1947 Aerial convection of smallpox infection Millard CK Public Health 1947 60(8): 165
1947 The present status of the control of air-borne infections. Report of the Subcommittee for the Evaluation of Methods to Control Air-borne Infections, of the Committee on Research and Standards Perkins JE, Chair, Gilcreas FW, Hollaender A, Langmuir AD, Secy, Robertson OH, Wells WF, Wheatley GM, Yaglou CP Am J Public Health 1947 37(1): 13-22 DOI: 10.2105/AJPH.37.1.13
PMC: PMC1623240
1948 Air infection with dust liberated from clothing Duguid JP, Wallace AT Lancet 1948 252(6535): 845-9 DOI: 10.1016/s0140-6736(48)91428-7
1955 [The transmission mechanism of smallpox] German Elst E Arztl Forsch 1955 9(1): 13-32
1957 Survival of variola virus in raw cotton MacCallum FO, McDonald JR Bull WHO 1957 16(2): 247-54 PMC: PMC2538235
1958 New sampler for the collection, sizing, and enumeration of viable airborne particles Andersen AA J Bacteriol 1958 76(5): 471-84 DOI: 10.1128/jb.76.5.471-484.1958
PMC: PMC290224
1961 Airborne micro-organisms: survival tests with four viruses Harper GJ J Hyg (Lond) 1961 59(4): 479-86 DOI: 10.1017/s0022172400039176
PMC: PMC2134455
1962 Airbourne spread of smallpox MacCallum FO Intl Symp on Smallpox Vaccination, Asso Intl Soc Microbio, Lyon, Dec 1962 Basel, S. Karger, 1962, pp 43-6 DOI: 10.1159/000389819
1964 Inactivation of airborne viruses by ultraviolet irradiation Jensen MM Appl Microbiol 1964 12(5): 418-20 DOI: 10.1128/am.12.5.418-420.1964
PMC: PMC1058147
1966 [On the demonstration of airborne viruses. Experiments on the sedimentation of viruses in aerosols] German Petmezakis J Zentralbl Bakteriol Orig 1966 201(3): 273-301
1966 Quantitative studies on fabrics as disseminators of viruses. I. Persistence of vaccinia virus on cotton and wool fabrics Sidwell RW, Dixon GJ, McNeil E Appl Microbiol 1966 14(1): 55-9 DOI: 10.1128/am.14.1.55-59.1966
PMC: PMC546618
1969 A note on the studies on the possibility of certain varieties of fish playing any role in the spread of smallpox Sarkar JK, Ray S J Indian Med Assoc 1969 53(7):339-40
1970 An adhesive surface sampling technique for airborne viruses Thomas G J Hyg (Lond) 1970 68(2): 273-82 DOI: 10.1017/s0022172400028734
PMC: PMC2130810
1970 Sampling rabbit pox aerosols of natural origin Thomas G J Hyg (Lond) 1970 68(4): 511-7 DOI: 10.1017/s0022172400042443
PMC: PMC2130863
1970 An airborne outbreak of smallpox in a German hospital and its significance with respect to other recent outbreaks in Europe Wehrle PF, Posch J, Richter KH, Henderson DA Bull WHO 1970 43(5): 669-79 PMC: PMC2427800
1970 Airborne transmission of smallpox WHO Chron 1970 24(7): 311-5
1971 Can Culex pipiens fatigans or Aedes aegypti spread smallpox? A preliminary report Sarkar JK, Hati AK, Mitra AC Bull Calcutta Sch Trop Med 1971 19(2):35
1973 Air-transport, a main cause of smallpox epidemics today Hagelsten JO, Jessen K Aerosp Med 1973 44(7): 772-4
1973 Role of mosquitoes in the spread of smallpox Sarkar JK, Hati AK, Mitra AC J Infect Dis 1973 128(6):781-3 DOI: 10.1093/infdis/128.6.781
1974 Air sampling of smallpox virus Thomas G J Hyg (Lond) 1974 73(1): 1-7 DOI: 10.1017/s0022172400023767
PMC: PMC2130554

Variola Minor & Alastrim


1900-44

* Cited in Smallpox and its Eradication, Fenner et al, WHO 1988


Year Title Authors Source URL
1900 Remarks on the present mild type of smallpox; the symptoms and treatment Welch WM Tex Med J (Austin) 1900 15(8): 435-52 PMC: PMC9595733
1901 Notes on a mild type of small-pox: (variola ambulans?) Montizambert F Br Med J 1901 1(2106): 1134 DOI: 10.1136/bmj.1.2106.1134
PMC: PMC2400964
1901 Remarks on the present mild type of smallpox; the symptoms and diagnosis Welch WM Tex Med J (Austin) 1901 16(8): 341-55 PMC: PMC9591547
*1904 Amaas, or kaffir milk-pox de Korte WE Lancet 1904 163(4210):1273-6 DOI: 10.1016/S0140-6736(00)66565-0
*1911 [Studies on alastrim] German Aragao H de B Mem Inst Oswaldo Cruz 1911 3: 309-19
*1911 [Apropos of a very mild smallpox epidemic] French Carini A Bull Soc Pathol Exot Filiales 1911 4: 35-7
1914 Smallpox in New South Wales Can Med Assoc J 1914 4(8): 721-4 PMC: PMC406711
1915 The recent epidemic of small-pox in New South Wales: its diagnosis and prevention Armstrong WG Proc R Soc Med 1915 8(Sect Epidemiol State Med): 1-18 PMC: PMC2004206
1915 The nature of the recent small-pox epidemic in Australia: microbiological findings and animal inoculations Cleland JB, Ferguson EW Proc R Soc Med 1915 8(Sect Epidemiol State Med): 19-40 PMC: PMC2004207
1920 The relationship of smallpox and alastrim Copeman SM Proc R Soc Med 1920 13(Sect Epidemiol State Med): 237-60 PMC: PMC2152677
*1921 Alastrim in Jamaica MacCallum WG, Moody LM Am J Epidemiol 1921 1(4): 388-409, DOI: 10.1093/oxfordjournals.aje.a118044
*1922 Alastrim; or Kaffir milk-pox Moody LM Ann Trop Med Parasitol 1922 16:21-46
1924 A case of alastrim (Kaffir pox) Mukerji BK Ind Med Gaz 1924 59(2):89-90 PMC: PMC5172660
1927 A short note on mild small-pox in Patna Das JL Ind Med Gaz 1927 62(11): 634 PMC: PMC5197967
1927 Notes on two cases of alastrim Ghosh JM Ind Med Gaz 1927 62(10):572 PMC: PMC5197761
1928 Alastrim a form of smallpox Am J Public Health 1928 18(2): 203-4 DOI: 10.2105/ajph.18.2.203
PMC: PMC1580386
1929 Alastrim or small-pox? Nag SC Ind Med Gaz 1929 64(2): 90 PMC: PMC5164333
*1929 [Variola and alastrim] Sobernheim Zentralbl Bakteriol Orig 1929 110:97-115
*1932 Permanency of the mild type of smallpox Chapin CV, Smith J J Prev Med 1932 1(1-39)
*1935 [Culture of the alastrim virus on the membranes of the chick embryo] French Torres CM, Teixeira J de C C R Seances Soc Biol Fil 1935 118:1023-4
*1936 Further studies on the pathology of alastrim and their significance in the variola-alastrim problem
Lloyd Roberts Lecture: Sect of Trop Dis & Parasitol
Torres CM Proc R Soc Med 1936 29(12): 1525-40 PMC: PMC2076288
*1939 Cross immunity experiments in monkeys between variola, alastrim and vaccinia Horgan ES, Haseeb MA J Hyg (Lond) 1939 39(6): 615-37 DOI: 10.1017/s0022172400059556
PMC: PMC2199512
1940 Cross-immunity between variola, vaccinia, and alastrim Br Med J 1940 2(4154): 228 PMC: PMC2178737