Victors Fear Old Foe: Pox

Joaquin Duarte thought his 1939 battle with smallpox--the sweats, the delirium and the scarring sores--was among the scourge's last gasps in this country.

Six decades later, he is sweating over the possibility that terrorists will bring it back.

"It's pretty bad," said Duarte, 81, recalling the days he lay inside his "covered wagon," a tent of blankets, struggling not to scratch the pus-filled pox. "I wouldn't want anybody to go through it. It's an awful thing to go through."

Health officials are worried, too, that one of the greatest triumphs of public health--the eradication of this terrible virus--could be in peril. So much so that they are ordering 300 million doses of vaccine, enough for every American, in case smallpox reemerges.

Federal health officials have also begun inoculating doctors, lab workers and other experts against smallpox, and training them to identify and contain possible outbreaks.

As survivors and medical veterans of the last smallpox war well know, there are good reasons for hope and fear.

Sixty or 70 years ago, public health officials were able to quickly respond to outbreaks and vaccinate enough people to prevent mass infections. But survivors in this country, such as Duarte, had a relatively mild form of smallpox, which kills 1% of those it infects.

Experts believe that the type of smallpox used in a bioterrorist attack would be much more virulent, killing 30% or more.

In any case, smallpox is highly contagious, making it an even more frightening prospect than anthrax, a noncontagious disease that in the past month has severely shaken the nation.

The chances of smallpox being used as a biological weapon remain small, experts say--but with anthrax now being sent through the mail, no one is feeling complacent.

Smallpox survivors and their caretakers can take pride, and even offer some lessons, in defeating a deadly disease. But they shudder at the thought of seeing it emerge again, perhaps more powerful and widely spread than before.

"I just imagine, if it starts spreading, how it [could] stop a country," said James Orr, 53, the last smallpox victim in North America.

Long before there was any such concept as terrorism, smallpox was sowing terror.

American colonists were so fearful of the scourge that many forbade their children to travel overseas--even to attend England's most prestigious colleges--lest they be infected. "The smallpox was always present, filling the churchyard with corpses, tormenting with constant fears all whom it had not yet stricken," British historian Thomas Babington Macaulay wrote in his 1848 "History of England."