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Chapter 40

Smallpox: Osteomyelitis Variolosa and Smallpox Pneumonia

and Tanapox (Monkeypox)

Fig. 40.1. The suffering of smallpox has disappeared; the scars and deformities persist.

As far as is known, the smallpox virus now exists (2000) in only two places on earth; one laboratory in Russia and one in the United States. After further research, it is planned to destroy both of these cultures. History does not record any disease that has been totally eradicated, until now (Fig. 40.1).

So this is a historical record: if the World Health Organization is a correct, the scourge of smallpox no longer exists to ravage mankind as it has for centuries, outdating human history. When death was not the outcome, it left ugly scars, affecting kings, pharaohs, and peasants indiscriminately. It is known that Ramses V of Egypt was afflicted and scarred by smallpox and that before 1000 B.C. Chinese physicians knew how to immunize their patients. It is also sure that person to person contact is the most epidemiologically significant way to transmit the infection, but that the virus may remain viable in the dust for 2 years or more.

This chapter was initially drafted for the first edition of this textbook, prior to the WHO proclamation in late 1979, and therefore is written in the present rather than the past tense. However, even if smallpox has disappeared, its legacy will be seen in the tropics and perhaps elsewhere for many years to come. It is still (2000) listed as a significant cause of blindness in Ethiopia, and a Vietnamese patient with fusion of both elbows from childhood smallpox was seen in Sacramento in the late 1980s. Its similarities to other viral infections of bone will be a useful source of comparison. Moreover, the late development of pulmonary calcifications has been ascribed to contact with smallpox patients many years previously, adding yet another possible cause of scattered calcified pulmonary nodules.

Note: The World Health Organization General Assembly gave instructions that all the remaining stocks of smallpox (variola) virus were to be destroyed on the 30th of June, 1999 (Medicos Mundi International 57:44, 1996). However, the executive board of WHO has recommended that 500,000 doses of smallpox vaccine should be kept by the organization. The recommendation was not carried out because of the fear that important scientific data and the means to develop new antiviral agents might be lost. It was also feared that the smallpox viruses might already be in the hands of unfriendly organizations. At the end of 1999 stocks of the virus were still maintained in the United States and Russia.

Synonyms

Osteomyelitis variolosa. Smallpox osteomyelitis. Smallpox arthritis. "Bone disease" in smallpox. (Alastrim=variola minor. Asiatic smallpox =variola major. Cowpox =vaccinia. Monkeypox=Tanapox. Chickenpox =varicella.) Sp: Variola. Viruela. Fr: Variole. Ger: Pocken. Blattern.

Definition

Smallpox is infection by the variola virus. Osteomyelitis variolosa is an infection of bone and joints by the smallpox virus. Smallpox handler's lung describes the calcified foci which develop after smallpox pneumonia.

Geographic Distribution

Smallpox previously occurred throughout the world. It was first eradicated in Europe and North America and then throughout much of Africa. It continued to occur until fairly recently in South America, India, and parts of Asia, and most recently in Ethiopia and Somalia. Apart from fatal cases in laboratory workers, smallpox has apparently been completely eradicated since 1977.

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Copyright: Palmer and Reeder