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

1. 

   View larger version:

   • In this window
   • In a new window

   Figure 1. 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.). An example of clinical notes.
2. 

   View larger version:

   • In this window
   • In a new window

   Figure 2. 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.). Day 7 of the varioloid form of smallpox in a 34-year-old man.
3. 

   View larger version:

   • In this window
   • In a new window

   Figure 3. 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.). Day 8 of variola vera in a 3.5-year-old girl with an unidentified nurse at the Southampton Street smallpox hospital.
4. 

   View larger version:

   • In this window
   • In a new window

   Figure 4. 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.). An unidentified nurse cleaning the eyes of a delirious 45-year-old man with variola vera (date of onset uncertain).
5. 

   View larger version:

   • In this window
   • In a new window

   Figure 5. The patient at day 4 ( ), day 6 ( ), and day 11 ( ) 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.). A 23-year-old unvaccinated woman with variola vera.topmiddlebottom
6. 

   View larger version:

   • In this window
   • In a new window

   Figure 6. Survival stratified by vaccination status ( = 0.005) ( ); type of vaccination (global = 0.012; = 0.005 for successful vs. none; = 0.034 for recent primary vs. none) ( ); disease severity ( < 0.001) ( ); and age (global = 0.015; = 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; = 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) ( ). Symbols indicate deaths, and the numbers of patients at risk are indicated at 7-day intervals along the x-axis. Survival of patients with smallpox from date of symptom onset.Ptop leftPPPtop rightPbottom leftPPPbottom right

• Copyright ©2004 by the American College of Physicians