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One of the oldest diseases written throughout history, smallpox can trace its' history back to 1122 B.C., in China. The Pharaoh Ramses V may have died from smallpox in 1157 B.C. The disease ravaged Africa and Asia and finally reached Europe in A.D. 710. The much-revered Spanish explorer (read that plunderer) Hernando Cortéz brought smallpox on board his ships in 1520, and 3.5 million Aztecs died within two years. The effects on the Inca were even more devastating.

In Europe in the eighteenth century, a smallpox epidemic killed every seventh child born in Russia and every tenth child born in Sweden and France. Queen Mary II of England, Emperor Joseph I of Austria, King Louis I of Spain, Czar Peter II of Russia, and King Louis XV of France all died as a result of smallpox.

Small pox is a killer disease, pure and simple. However, due to the first truly international effort to eradicate a disease, smallpox is now not considered to be an international health threat...unless some idiot uses it for a biological weapon.

What is Smallpox?

Smallpox is caused by one of two virus variants known as Variola major and Variola minor.

V. major is the more deadly form, with a typical mortality of 20-40 percent of those infected. The other type, V. minor, only kills 1% of its victims. Many of the survivors of this disease are left blind in one or both eyes from corneal ulcerations and persistent skin scarring — pockmarks. As deadly as this disease is, it is not as infectious as chickenpox.

In order to "catch" smallpox, you have to be in close contact (6-1/2 feet) of an infected person who has developed smallpox pimples, usually in the mouth of the victim. As the victim breathes, he or she exhales droplets of the smallpox which are in turn inhaled by others. It is estimated that should this disease start up again, every victim of the disease would infect at least 14 to 20 other people.

Smallpox Progression

The incubation period (the time between exposure to disease onset) is from seven to seventeen days. The first symptoms will be high fever, fatigue, headache, lack of energy (possibly physical collapse), and backache. These symptoms will usually appear twelve to fourteen days after exposure. The rash or pox, usually breaks out three days after these symptoms appear. Smallpox is the most contagious during the 7 to 10 day period after exposure...however, this time may vary.

The first rash visible develops as tiny pink spots in the throat and mouth. From there, the spots spread out to the face and forearms, then to the trunk and legs. One of the key differences between the smallpox rash and the chickenpox rash is that only smallpox will severely cover the soles of the feet and the palms of the hands. If you have chickenpox, the soles of the feet and palms of the hands will have only very few (or no) pustules.

The rash spreads out over the body as shown in the diagram on the left.

The victim will remain contagious until the scabs form over the pustules and the last scab falls off. Even then, the virus can be found in the scabs, so treat all clothing and linen as biologically contaminated materials.

V. Minor, the less severe variation of smallpox, will have fewer lesions (pustules) and milder symptoms. People with past vaccinations may have milder symptoms and may recover more quickly. But, since all routine vaccinations stopped in 1972, most children will not have any vaccination against this deadly disease.

I Remember When...

RogueTurtle vividly remembers being vaccinated for smallpox as a youth. Each vaccination left a small circle of scar tissue either on the arm or hip of everyone vaccinated. Look at the adult members of your family. If they have a round scar on the shoulder area of the arm, or around the "panty line" area of the hip or thigh, then they were vaccinated at least once for smallpox. The bad news is it may, or may not be effective against a disease contracted today. I personally will not count on it working. I'm too old.


After the terrorist attack on the World Trade Center in 2001, the US government sped up production of smallpox vaccination. However, they have not given this vaccination out for the general public as of today (2006). Only those people who are or would be actively involved with working with the disease have been vaccinated. These people include laboratory technicians, investigators, doctors and nurses, and others listed by CDC as the most likely to develop smallpox during their daily work routine.

Should an outbreak of smallpox be found, it would be considered a MAJOR HEALTH EMERGENCY. CDC would ship out the vaccines and all people in the area of exposure would be vaccinated, as well as those people in close contact with these people. However, with the long incubation times and ready availability of air travel, catching ALL the victims would be very difficult.

As of 2004, the CDC reports that vaccines are available (as needed) for every citizen of the United States.

The history of the smallpox vaccination is rather unusual. Doctor Edward Jenner is thought of by most school books to have invented the smallpox vaccination, but there were many attempts prior to his success. Unfortunately, most of these attempts used the live smallpox virus to innoculate people. In this case, many people died as a result of getting vaccinated. Doctor Edward Jenner, himself a victim of a vaccination that went wrong, discovered that milkmaids who worked daily with cows, usually contracted a mild disease called "cow pox". When an epidemic of smallpox hit the area, none of these milkmaids contracted smallpox. Using the less lethal cow pox virus as the basis of his vaccine, the smallpox disease started, for the first time, to become controllable on a world-wide basis.

Death from Smallpox

Deaths from smallpox are caused in the same manner as in burn victims. The pustules, sometimes forming sheets of skin lesions, cause massive losses of body fluids, proteins and electrolytes beyond the capacity of the body to replace them. These skin lesions will break open, leaking out body fluids and introducing any number of infections the body simply cannot fight.

There is also another variant of V. major, known as hemorrhagic smallpox, that has a fatality rate of 96 percent. This rare form has an entire different set of symptoms. The skin does not blister, but remains smooth. Instead, bleeding will occur under the skin, making the skin look charred and black. This has been known as the "black pox". The eyes may also hemorrhage, making the whites of the eyes turn deep red. If the victim lives long enough, these red eyes will eventually turn black. At the same time, bleeding begins in the organs. Death may occur from bleeding (fluid loss), or other causes such as brain hemorrhage. Infections may be introduced since the skin and intestines are no longer a barrier and can lead to multi-organ failure. Depending on the virulence of the strain of smallpox, this form may occur in anywhere from 3-25% of all fatal cases. The same virus causes all variants — the difference is in how people react to the virus once exposed.

Before smallpox was eradicated in the late 1970's, the death rate for unvaccinated persons contracting V. major was about 30%. For V. minor, the death rate was only about 1%.

Bio-terrorist Threat?

In 1978, a research laboratory in Birmingham, England, had an escape of a laboratory sample of smallpox virus. One person died as a result of this accidental release. Professor Henry Bedson, the Professor responsible for the unit, killed himself. Some good did come out of this incident:

In that same year, it was agreed upon by all members of the World Health Organization (WHO), that all known stocks of smallpox virus be destroyed. Only two labs, the CDC in the United States, and the Vector Institute in Russia, were allowed to keep small samples. In 1993, ‘94, ‘95, and ‘96, even these stocks were ordered by WHO to be destroyed. This destruction has not happened, as both nations keep samples for "research" purposes.

According to Senator Bill Frist, M.D., in his book When Every Moment Counts, Russia manufactured over 20 tons of smallpox virus (in the 1980's) specifically designed for use in bombs and intercontinental ballistic missiles. This stockpile is reportedly destroyed, but with the collapse of the old Soviet Union, nobody is absolutely certain ALL of it has been destroyed.

There is no naturally occurring source of smallpox virus. It is not found naturally in either animals or in the soil. So, only the use of the pre-existing virus could be used to once again introduce smallpox to the world. Nobody has been vaccinated against smallpox for at least two generations. Terrorists who use smallpox run the risk of wiping out their own people as well as the rest of the world. The risk of using the smallpox virus is very high.

However, the possibility exists that the crazed "Islamo-nazis" currently terrorizing the world could get their hands on a sample. It only takes one tiny virus cell to culture billions of others. While technically more difficult to manufacture than anthrax, this threat must be taken seriously. Are they crazy enough to use them? Your guess is as good as mine.


Every Moment Counts. From the onset of symptoms, the speed of diagnosis will directly effect how fast CDC sends out the proper (new) vaccines to innoculate all the parties involved. Vaccination can offer protection for previously un-vaccinated persons if given within one to three days (maybe as long as four days) after exposure. Vaccinations after this time period may be useless.

Vaccinated persons may show no symptoms of smallpox, even if exposed. If a vaccinated person does show symptoms, their prognosis for recovery is good, as the disease is usually less severe and is not likely to be fatal.

From a strictly survivalist point of view, this absolute need for immediate medical attention after exposure is BAD NEWS. During crisis situations, getting into and out of medical facilities may be extremely difficult, if not impossible. Once the news leaks out there has been a bio-terrorist attack of the smallpox virus, everyone in the country will be lining up to get the vaccine, even though they were not ever exposed. Standing in a line for vaccine could literally be more fatal than the disease. We've all seen movies and TV coverage of "Americans behaving badly". This would be 100 times worse. There would have to be armed troops guarding the facility giving the shots to maintain law and order. I love my fellow Americans, but they can be a pain in the — sometimes. Waiting in line for two days to get vaccinated, when most of the people in the line haven't been exposed, will REALLY TICK ME OFF!

More bad stuff

Most of today's young doctors and nurses have only read about smallpox, and have never seen it before. Unless someone with more experience is around, the possibility of delay due to under-experienced medical staff is very high. Also, once you ARE diagnosed with smallpox, there is no specific treatment for smallpox other than making the patient as comfortable as possible. While there are some medications specifically designed for smallpox, they haven't been tested on humans since the medicines were developed AFTER the disease was eradicated. These will only be "test" medicines and may - or may not - be available to the general public.

Other alarming facts about vaccinations include many undesirable side effects:

  • Post-vaccination encephalitis may develop in 12.3 cases per million. Of those infected, 25% may die as a result of exposure to the vaccine.
  • Persons with reduced or weakened immune systems may not recover from the lesions from the vaccination, killing adjacent skin tissue and becoming infected. This infection could spread to other parts of the skin, bones and internal organs.
  • The vaccination can cause eczema, an itching inflammation of the skin with lesions. 38.5% per million may react in this manner.
  • About 6 to 9 days after vaccination, lesions caused by the vaccine virus erupt. While not usually fatal, they complicate medical treatment.
  • 529.2 cases per million may spread lesions from the vaccination from one person to another through close contact, or to other parts of their own body such as the face, eyelids, mouth, etc.
    Historically, you can expect one death per every 1 million vaccinations given to any population not vaccinated previously. Previously vaccinated deaths may be about 1 death per 4 million re-vaccinations.

None of the above estimates apply to people with HIV infections or those taking drugs to suppress rejection of organ transplants, and those being treated for cancer. These people are at a much higher risk of having serious side effects from smallpox vaccinations.


The CDC estimates that 70% of all children receiving smallpox vaccination will have a fever of 100 degrees (f.) or higher for one or two days; and 15 to 20% of those will have a fever above 102 degrees (f.).


Pregnant women have a heightened morbidity rate to smallpox. One study showed the rate was 27% in vaccinated patients and 61% in unvaccinated patients. This differs from the non-pregnant morbidity rate of 6% (vaccinated) and 35% (unvaccinated). Pregnant women are the most likely group to develop the extremely fatal hemorrhagic variant of smallpox. Note: Morbidity rate is NOT the Mortality rate. Morbidity means you are more likely to get the disease, but not necessarily die from it. There is no information available as to the effect smallpox has on the fetus.

All these side effects of smallpox vaccination are the real reason routine smallpox vaccinations were discontinued world-wide. As the smallpox disease became less and less a threat, we would have killed off more people with the vaccines than from the disease itself.


Persons with known diagnosed smallpox must be isolated from non-infected people. Special quarters must be set up for the daily care and feeding of the infected person(s). To be considered a true isolation ward, the building (or rooms) must have its own air-conditioning, heating, and ventilation systems that exhaust 100% of the air to the outside through a HEPA filter — or be at least 100 yards from any other occupied building or area. Anyone entering this facility (room) must be vaccinated. Quarantine for patients must be until the last pustule scab falls off, about 28 days after onset of the disease.

The isolation building (room) must have its own water, electricity, communications systems and the ability to support medical treatments that may include IV's, oxygen machines, and a range of specialized medical equipment. Unless this area is already set up in your pre-planned bug-out shelter, you may have to use public medical facilities to prevent the spread of the disease to others in your survival group. The hard fact is that it is better to lose one to save ten. Nobody said all survival decisions were easy.

All medical equipment, bedding, bandages, and human waste must be considered contaminated medical waste and disposed of accordingly. In hospitals, this material is placed into red plastic bags and sent to a specialized incinerator. Bedding can be sterilized by placing in boiling water for 15 minutes. However, handling the contaminated bedding (or clothing) is very dangerous to the people who clean up these items.

The use of Ultra Violet light will kill the smallpox virus, but the virus may live for as long as 24 hours in protected areas. If the virus release is from an aerosol, it is estimated most of the virus will die within 6 hours in an atmosphere of high temperatures and humidity. It will take longer in cooler, drier areas.

Laundry should be boiled in hot water with bleach added. Surfaces that have possibly been exposed to the virus can be cleaned with bleach, hypochlorite and quaternary ammonia (hospital cleaning supplies).

Scabs may hold live virus for up to 3 weeks. Past medical experiments have detected the virus up to 13 YEARS of sitting on a shelf, however it is doubtful it will be infectious in humans after this period of time. The word "doubtful" implies it just might be infectious. All scabs should be destroyed by incineration.


Smallpox is officially eradicated from the world. However, the virus is still alive and well, stored in somebody's closet. Any virus held by humans is subject to human perversity and human error. This leaves a small window of opportunity for homicidal or pathological persons to get access to a disease that could devastate the entire world. There would be no containing a bio-terrorist attack using smallpox. With the long time between exposure and the first symptoms of the disease, it could spread world-wide overnight.

There are vaccinations available for smallpox, but as of right now they are NOT being routinely given out due to the multitude of potentially serious side effects.

As survivors, we can only hope that sanity and humanity will prevent the use of this dreadful disease as a weapon of mass destruction. Once used, the cat is once again out of the bag. Millions of people will die as a result of even one release in a highly populated area. God help us all.