A Missive on Smallpox

[Hanrahan 2983]

C H A R L E S   N A P I E R, 

 

D O C T O R    O F M E D I C I N E 

 

O N   T H E   S U B J E C T   O F

 

V A R I O L A

O R

S M A L L P O X

 

 

 

P R I N T E D    I N H E L E N A

 

B Y

 

 T H E   I M P E R I A L   M E D I C A L

A U T H O R I T Y

 

I N 

 

A N N O   D O M I N I   MDCCXXXVI

 

    I N T R O D U C T I O N,

 

Variola is an infectious Pox that comes in two major variants - Variola Majora, and Variola Minor. Initial symptoms of the disease include fever, and vomiting. Following this, sores form orally, and a rash appears over the skin. Over a period of succeeding days, the rash turns into bumps filled with fluid, with a dent in the center. Presuming survival of the pox, the bumps would then scab over, leaving pocky scarring. There is no known cure for the disease, but later mentioned - there are ways of combating it before one catches it. 

 

The disease is extremely fatal, unpredictable, and is famously hard to track and trace its source and path through populations. Although records are sparse, it can be estimated that it’s common rate, excluding spikes in activity during plagues, around one-hundred thousand die annually in both rural and urban populations in the Empire. Up to four-hundred thousand are infected annually, and of those that do not die from the disease, a third are left blind or invalided. 

   

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Signs and Symptoms

The period between infection and the exhibition of Symptoms is on average, two weeks long. Once infected, the disease begins to work on the lungs during the incubation period, then bursting forth to infect the blood, starting the first showing of symptoms. Initially, it can be misidentified as influenza, or the common cold, boasting a fever, muscle pain, headache, and the need to lay down. As part of the incubation seems to strike the intestines, nausea and vomiting may occur. By the end of two weeks, the first lesions begin to appear, reddish spots occurring on the mouth, tongue, and throat. If a person boasted a fever, it would fade by this point. As time progresses, these lesions would grow in size and frequency, finally rupturing, releasing infected effluvia into the mouth. 

 

    After a day of the appearance of lesions, the most tell-tale sign of the disease, the pimpling of the skin would begin to occur. First appearing on the forehead, they would travel down the body, covering the whole face, and chest. Extremities are typically less covered, the macules (Variola Pimples or Pox). From beginning to end, the appearance of the macules would occur over a thirty hour period, and once passed, no more would occur. It is from this point that the various routes of the disease may engage - Ordinary, Malignant, and Hemorrhagic.

 

Ordinary Variola is by far the most common of the diseases paths, occurring in over ninety percent of patients. In this path, the macules become papules, or raised tissues over a day. Following that, over two or three more days, the papules become pustules, the most common feature of the fatal disease - Opaque and turbid, containing an unfortunate fluid of infection. By day seven of the divergence from macule maturation, the pustules would be round, tense and firm to the touch, giving the sense of an embedding in the skin. Fluid would leak from these, and by the end of two weeks after initial macule divergence, the pustules will deflate, dry up, and scab. Two more days, and the scabs flake off, leaving a de-pigmented pattern of scars over the body. Ordinary Variola produces a discrete rash, in which the pustules stand out separately from. The distribution of the rash is most dense upon the face, on the extremities, rather than the chest, and on the palms of the hands and soles of the feet. In fatal cases, the pustule blisters would merge into a mass sheet of pustules which detach entirely during the scabbing phase, causing a general sloughing of tissue en masse. Those with sheeting ordinary Variola remain ill after scabbing, and hold a fatality rate of sixty percent.

 

Malignant Variola is quite rare, forming only ten percent of patients - but overwhelmingly affecting children, seventy percent of those surveyed with Variola. In this variant, the pustules remain flush with the skin, not beading outwards like in the Ordinary strain. It is accompanied by severe fever and infectious serum in the blood. Rashing on the tongue and roof of the mouth is significantly more intense. The lesions, or pustules develop slowly, and appear to be buried within the skin. They are soft to the touch, and contain little fluid. Many contain micro-hemorrhages. The fatality rate of Malignant Variola is ninety percent.

 

Hemorrhagic Variola is the most severe, the primary feature being extensive bleeding into the skin, mucous membranes, and intestines. This form develops in only two percent of cases, and only among adults. In this strain, the skin does not blister, but remains smooth. The effect of the disease is under the skin, where bleeding occurs, causing a blackened effect over the body. Death occurs on day five of this strain exhibiting it’s particular signs. The fatality rate of Hemorrhagic Variola is seventy percent. 

   

 

 

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Cause and Diagnosis

 

The cause of virtually all diseases is unknown, however, leading theorists in the medical community have come to some credible theories. As infection forms upon wounds and spreads, growing it’s noxious tissue and fetid liquid, so do other diseases, in diminutive form. Progress with the Microglass has lead to breakthroughs in medical theory, suggesting that there is a living agent in infectious tissue - no larger than a speck of dust, yet disastrous in effect. Laboratory studies have shown in mice and rabbits that these living agents may travel via contact, air, or water, depending on the variety. Presuming this to be the case, it is highly probable that the agent that causes the Variola is of the same design, if not the same effect. 

 

Thusly, the cause will be contact with the agent, most probably through ingestion - the agent on food, water, or the hands and skin. During peak infection, it is absolutely true that physical contact with a person exhibiting the disease dramatically increases the risk of contagion spreading, and should only be done in a carefully prepared and monitored environment. 

 

As spoken above in the previous chapter, Diagnosis can be made via the observation of critical features of the disease, thusly being:

 

Acute fever.

Development of a rash over the face.

Development of deep seated pustules without any other apparent cause.

   

 

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Variolation and Preventative Medicine

 

    The report thus far is grim, but hope lay yet. Although relatively new, having only been tested in two populations, there is a procedure called Variolation, pioneered by Dr. Charles Napier. As the beasts of the land, such as sheep and goats are related - thusly too, seem diseases. Many a farmer knows well of Cowpox, a similar malaise that affects cattle in much the same way as Variola affects man. However - if one takes a scraping of lesionary pus from a cow suffering from cowpox, and injects it under the skin - the  person in question suffers diminished effects, and gains immunity to Variola proper. 

 

During a test in one of the populations, three hundred men were Variolated during a Variola outbreak. Of the Variolated population, only six men died, whereas nearly a thousand perished who were unvariolated. Without a doubt, this preventative measure is successful beyond a doubt, and ought be applied Empire-wide. 

 

A Variolation.

 

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[Ixli 1472]

“I didn’t even know there were a thousand people to begin with.....” mumbled Silir

[Vermy 1484]

Sulraell wonders if this book is for sale...

[Ducklingator 795]

Daniel, a local druidic dedicant, aims for the top and contracts bigpox.

[Jentos 9422]

Screaming. Running. Fleeing. The Marked barrelled through pale plains as a living torch; a blazing wight. Screams echoing from it’s hallowed maw, screaming of blasphemies and Pale Cities, and amongst other things, a deceased, wicked child dead of the pox. 

[Callistus 988]

“Pox on it, we’re all dead! Dead, I tell ya! ‘less. . .

Oh, but arm yerselves with iron an’ hide, heave silver crosses blest with holy water at the dawn of night, an’ we’ll plough ‘em all to hell like some men do swine!” raves madly a local blacksmith within the warmth of his scorching forge; whereon darken steel was battered, and ashen flames lay strewn upon his vestment in a most unruly of manners; knowing with great certainty that the only way to ward off disease and plague, is to sow carnage and let seep unto Earth the blood of the ill.

 

Even God envied him of such ideas!