CHAPTER XLVIII 

 SMALLPOX 



SMALLPOX or variola is one of the most virulent of infectious diseases. 

 Throughout history it has been a severe scourge of mankind, prevailing 

 in China and other Eastern countries many centuries before Christ 

 and sweeping through medieval Europe, especially at the time of the 

 Crusades, in a series of severe epidemics. All races of men are suscep- 

 tible and no age from childhood to senility is exempt. In modern times 

 the disease is endemic in most uncivilized countries, especially those of 

 the East, and occurs sporadically in all parts of the globe. Owing to 

 rigid enforcement of vaccination and of quarantine laws, however, the 

 disease has been practically eradicated from civilized countries. 



The etiological factor which causes smallpox is still unknown. 

 Numerous researches aimed at the discovery of cultivatable microorgan- 

 isms in the lesions or blood of infected patients have met with uniform 

 failure. Streptococci, though often found in the smallpox vesicles 

 and pustules, and often undoubtedly contributing materially to the fatal 

 outcome of the disease, may be regarded as purely secondary in signifi- 

 cance. 



Communications which have claimed the discovery of a protozoan 

 incitant of the disease have, on the other hand, been numerous and, in 

 some cases, have seemed plausible. Yet absolute proof has always been 

 lacking. The literature on this question is extensive and some of the 

 earlier contributions, such as those of Griinhagen, 1 of Van der Loeff, 2 

 and of Pfeiffer, 3 possess historical interest only. The work which, of re- 

 cent years, has attracted the most serious attention to this subject is 

 that published by Guarnieri 4 in 1892. This observer found, in the deeper 

 cells of the epithelium covering the pustules, both of smallpox lesions 

 and of vaccination lesions, small bodies which were easily stained by 

 hematoxylin, safranin, or carmin. Similar bodies could be observed in 



1 Grunhagen, Arch. f. Dermat. u. Syph., 1892. 



2 Van der Loeff, Monat. f. prakt. Dermat., iv. 

 *L. Pfeiffer, Zeit. f. Hyg., xxiii. 



*Guamieri, Arch, perle sc. med., xxvi, 1892; Cent. f. Bakt., I, xvi, 1894. 



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