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

View larger version (90K): [in a new window]   Figure 1. An example of clinical notes. Clinical records were compiled in a single, bound book. Demographic information, smallpox type, and vaccination history were recorded at the beginning of a patient's record (name, age, and marital status are not shown but were listed at the top of the page). The patient was a 43-year-old woman who was discharged "well" on 22 March 1902. (From clinical records of the Southampton Street smallpox hospital, Francis A. Countway Library of Medicine, Boston Medical Library, Boston.).

View larger version (126K): [in a new window]   Figure 2. Day 7 of the varioloid form of smallpox in a 34-year-old man. The patient had been successfully vaccinated in infancy and was discharged "well" 2 weeks later. (From clinical records of the Southampton Street smallpox hospital, Francis A. Countway Library of Medicine, Boston Medical Library, Boston.).

View larger version (123K): [in a new window]   Figure 3. Day 8 of variola vera in a 3.5-year-old girl with an unidentified nurse at the Southampton Street smallpox hospital. The patient had been unsuccessfully vaccinated 3 months before admission. Pustules appear in the same stage (monomorphic)—a characteristic feature of smallpox. She was discharged "well" 1 month later, although facial pitting was noted. (From clinical records of the Southampton Street smallpox hospital, Francis A. Countway Library of Medicine, Boston Medical Library, Boston.).

View larger version (123K): [in a new window]   Figure 4. An unidentified nurse cleaning the eyes of a delirious 45-year-old man with variola vera (date of onset uncertain). The patient had a history of successful vaccination in infancy. On discharge 1 month later, he was described as "well": "weak on legs but is apparently mentally sound ... has one discharging boil on legs." (From clinical records of the Southampton Street smallpox hospital, Francis A. Countway Library of Medicine, Boston Medical Library, Boston.).

View larger version (58K): [in a new window]   Figure 5. A 23-year-old unvaccinated woman with variola vera. The patient at day 4 (top), day 6 (middle), and day 11 (bottom) after the onset of illness. There appear to be purpuric lesions on days 6 and 11. A diagnosis of a hemorrhagic form of smallpox had been considered by staff shortly after admission. The patient died on day 12. (From clinical records of the Southampton Street smallpox hospital, Francis A. Countway Library of Medicine, Boston Medical Library, Boston.).

View larger version (23K): [in a new window]   Figure 6. Survival of patients with smallpox from date of symptom onset. Survival stratified by vaccination status (P = 0.005) (top left); type of vaccination (global P = 0.012; P = 0.005 for successful vs. none; P = 0.034 for recent primary vs. none) (top right); disease severity (P < 0.001) (bottom left); and age (global P = 0.015; P = 0.008 for patients younger than 5 years of age vs. patients 5 years of age or older and younger than 45 years of age; P = 0.048 for patients 45 years of age or older vs. patients 5 years of age or older and younger than 45 years of age) (bottom right). Symbols indicate deaths, and the numbers of patients at risk are indicated at 7-day intervals along the x-axis.