Containing smallpox in Victorian London
|'This loathsome disease'|
It has been one of the biggest killers in history. Its eradication in the late 1970s has been one of the greatest successes of international cooperation in public health.
The incubation period of smallpox - the time between infection and the appearance of symptoms - is between seven and 17 days. The first symptoms include a high temperature, headaches and tiredness.
Between two and four days after the first symptoms, the characteristic rash appears on the face or in the mouth. It then spreads to the arms, hands, legs and torso.
The rash begins as reddish bumps, which then become blisters and, finally, blister-like pustules.
When the pustules dry up, the resulting scabs leave scars – the so-called 'pockmarks' characteristic of smallpox survivors. For some, death follows as the virus multiplies in the blood.
The misery of smallpox
It is difficult to imagine the misery smallpox patients experienced, but the case notes of a patient who died during the last of the great epidemics in 1901 will give an idea.
Smallpox as a contagious disease
Smallpox can be transmitted by direct physical contact. A person with smallpox is most contagious after the rash appears and remains contagious until the last scabs dry up.
The virus can survive up to a week outside the body, so contact with contaminated clothing or bed linen can also spread the disease.
In most western countries, smallpox was endemic - it was around all the time and did not need to be introduced from outside. At regular intervals serious epidemics - major outbreaks affecting large numbers of people - would erupt.
A smallpox attack gave the victim lifelong immunity – a person who survived the disease could not catch it a second time. So, at any time, there were always plenty of immune people around.
Epidemics did not occur until there were enough susceptible people – those who could still fall ill. These would mostly be very young children, who always suffered most during epidemics.
This chart traces the probable course of smallpox infection during an outbreak in 1887. It shows just how easily smallpox could spread.
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