Pox_ An American History - Michael Willrich [16]
Once the first virion penetrated the first cell in a person’s respiratory tract, the incubation period began. During this period, most people presented no symptoms—perhaps a little malaise or gastric discomfort. Meanwhile, the variola bricks silently but explosively replicated and spread in the host’s lymph nodes, spleen, and bone marrow. Over time, the virions piling up in the patient’s cells would number in the quadrillions. The incubation normally lasted from ten to fourteen days. The “Précis” gave twelve days as the norm. Such medical facts determined the politics of smallpox control. Conservative health officials enforced two weeks as the term a smallpox “suspect,” showing no symptoms, could be held against her will in a quarantined house or detention camp.33
When the symptoms finally came, they struck with such unexpected force that the “Précis” called the onset the “Invasion.” The patient felt a sudden chill, followed by severe pain in the loins and lower back, a splitting headache, and a high fever, in some cases surging to 106 degrees F. The pulse raced. Many patients vomited. The tongue grew thick with a brown coating; the appetite vanished, but the thirst was unquenchable. Some adults grew delirious. Some children were rocked by convulsions.34
In this early phase, as Dr. Long learned while attending to patients in the Iredell County pesthouse, smallpox remained inscrutable even to the trained medical eye. It could be typhoid fever, malaria, la grippe, or dengue. For the patient, these feverish days felt like a bad case of the flu, and some managed to carry on with their work. President Abraham Lincoln is believed to have been fighting the preeruptive fever of smallpox when he delivered the Gettysburg Address on November 19, 1863. One listener described the president’s appearance as “sad, mournful, almost haggard.” The rash appeared two days later.35
Smallpox patient from the Cleveland epidemic of 1901–03. This photograph was taken by Dr. Homer J. Hartzell, who headed the city’s smallpox hospital. COURTESY OF THE DITTRICK MEDICAL HISTORY CENTER, CASE WESTERN RESERVE UNIVERSITY
In a typical case, the fever fell by the second or third day. The constitutional symptoms abated. The patient felt better. So much so, a nineteenth-century nurse’s manual noted, that he might “suppose himself convalescent.” Unknown to the patient, the lesions had already begun rising, about twenty-four hours earlier, on the mucous surfaces of the mouth, the back of the throat, and more generally throughout the alimentary and respiratory tracts. Modern virologists call this eruption the “enanthem.” The enanthem turned the patient into a veritable mist machine of infection. The lesions evolved rapidly and broke down within two or three days, releasing virions in vast quantities into the saliva. For the next week or more, the patient’s every breath might launch a fusillade of invisible infective particles into the air. Although the patient could remain infectious for weeks, twentieth-century studies concluded that smallpox sufferers were most likely to infect others during the first week of their skin rash.36
From the perspective of the patient, and the turn-of-the-century physician, the true horror—and the real danger—of smallpox resided on the outside of the body, in a rash so spectacular and explosive it was universally called “the eruption.” It was the eruption that ancient commentators had described, and that peoples around the globe had painted, with pointillist precision, on the images and figurines of smallpox sufferers. It was the eruption that had caused a medieval bishop to give the disease its Latin name, variola, meaning “spotted.” (In England, the disease was known simply as “the pox” until the late