Smallpox Manifestations and Survival during the Boston Epidemic of 1901 to 1903

17 December 2002 | Volume 137 Issue 12 | Pages 993-1000

Clinical records of 243 patients with smallpox consecutively admitted to the Southampton Street smallpox hospital in Boston, Massachusetts, during the 1901–1903 epidemic were reviewed. Smallpox was divided into five categories of varying severity; 47% of patients had varioloid, a relatively mild form of the disease usually occurring in previously vaccinated individuals with incomplete immunity. Survival information is available for 206 patients, of whom 36 (17.5%) died. Vaccination status, disease severity, and age were associated with survival, whereas sex, birthplace, and race were not. While full recovery often took weeks, most deaths occurred 7 to 14 days after the onset of symptoms, and all deaths occurred within 18 days of symptom onset. Smallpox was eradicated worldwide in 1977, but knowledge of the disease is essential because its cause, variola virus, is considered a potential biological weapon.

Author and Article Information

From the National Cancer Institute and National Institutes of Health, Bethesda, Maryland; and Yale–New Haven Hospital, New Haven, Connecticut.

Acknowledgments: The authors thank Pierce Gardner and Mark Miller of the Fogarty International Center, National Institutes of Health; Stephen Katz of the National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health; and D.A. Henderson of Johns Hopkins University for their critical reading of this manuscript.

Requests for Single Reprints: Joel G. Breman, MD, DTPH, Fogarty International Center, National Institutes of Health, 16 Center Drive, MSC 6705, Building 16, Room 214, Bethesda, MD 20892; e-mail, jbreman{at}nih.gov.

Current Author Addresses: Dr. Albert: Rhode Island Hospital, Department of Dermatology, 593 Eddy Street, APC 10, Providence, RI 02903.

Ms. Ostheimer: Yale–New Haven Hospital, 20 York Street, Room 1096 CB, New Haven, CT 06504.

Mr. Liewehr and Dr. Steinberg: National Cancer Institute, Center for Cancer Research, Biostatistics and Data Management Section, 6116 Executive Boulevard, Room 702, MSC 8325, Bethesda, MD 20892.

Dr. Breman: Fogarty International Center, National Institutes of Health, 16 Center Drive, MSC 6705, Building 16, Room 214, Bethesda, MD 20892.