- The Washington Times - Sunday, November 18, 2001

Since childhood, we have all become familiar with the details, images, and personalities associated with our country's Revolutionary War, our struggle to become a new, independent nation. But what most of us are not familiar with is the reality that the colonies, while fighting the British, were also in combat with another terrifying enemy: smallpox.
In her extremely well researched (there are 80 pages of references) "Pox Americana," author and historian Elizabeth Fenn takes us on a step by step, year by year tour of the havoc caused by this highly contagious, viral disease during the years before and after America's Declaration of Independence. In the course of our journey, we learn a great deal both about smallpox and the enormous additional burden it placed on the ongoing military struggle. As the writer notes, "from 1775 to 1782 [smallpox] ravaged the greater part of North America from Mexico to Massachusetts,from Pensacola to Puget Sound."
Until recently, for those of us living in the year 2001, smallpox was a term that existed only in history books. The last naturally occurring case occurred in 1977, and routine vaccinations in this country ceased in 1972. But in post-September 11, 200l, America, all of us are much more interested in the subject, given the speculation (there is no hard evidence) that terrorists might have access to the virus and could deploy it as a biological weapon.
Back in the 1770s, the threat of smallpox came primarily from person-to-person contact with an infectious person (although there is some evidence that using infected items against the enemy was going on even then). And back then, as now, it was well understood that smallpox becomes contagious at a very specific time in the course of the disease 10 to 14 days after infection at which time the infected person experienced a spike in fever, followed by a rash, which evolved into the "pox" that are the signature of the disease and became very, very ill.
Indeed, following the journal entries of a young George Washington in 175l, historians have been able to pinpoint exactly when he was exposed to smallpox and when he became sick: The future president was accompanying his older half brother on a "health trip" fromVirginia to Barbados, believing that fresh air and a change in climate would cure the consumption (tuberculosis) which plagued (and eventually killed) his brother. While in Barbados, George Washington contracted smallpox, apparently suffering a relatively mild case of the disease.
Back in those days, there was no vaccine for smallpox. That medical miracle did not come about until 1796 when English physician Edward Jenner deliberately infected an 8-year-old boy with cowpox, a much milder disease that was closely related to smallpox. Several months later, he inoculated the boy with smallpox and found that there was no infection. But what was known by 1775 was that skin inoculation with the actual smallpox exudate known as variolation, named after the causative virus, variola produced a milder form of the disease than did natural infection by person-to-person transmission, yet caused the person to become immune to smallpox. With variolation (as opposed to post-Jenner vaccination) the person actually got smallpox.
The war itself enhanced the spread of the disease simply because of the constantly changing human contact, and introduction of the virus into totally vulnerable populations where smallpox had never been seen before. The virus spread impressively throughout the Continental Army, having a devastating impact. It sickened and killed American troops at Quebec and disabled them during the British occupation of Boston. Smallpox tormented George Washington again this time during a fierce winter at Valley Forge when he pondered whether or not to inoculate his soldiers, thus giving them smallpox.
By the end of the war, smallpox had killed far more people than had all the military weapons, and the dreaded viral disease had spread far beyond the war zone to the Southwest and the Pacific coast.
"Pox Americana" is a work of history, but one which will necessarily leave the reader to ask: If re-introduced in America in 2001, would smallpox have the same devastating effect as it did during the Revolutionary War? And, while the author does not directly address this, the answer here is "no."
Clearly, the diagnosis of even one case of smallpox in the United States (or anywhere in the world for that matter) would constitute a potential epidemic, a global catastrophe. But through standard, modern public health protocols (isolation, case contract tracing), vaccination of exposed or potentially exposed persons (vaccination within four days of exposure prevents or lessens the impact of the disease) and possible use of anti-viral drugs (primarily developed in the course of AIDS research), it is likely today, at least in the United States, that massive, explosive spread could be prevented.

Elizabeth M. Whelan is president of the American Council on Science and Health.

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