Shannon Leight (sleightly) wrote in little_details,
Shannon Leight

Smallpox: disease progression after rash develops

Setting: secondary world analogous to England in the 1350s, with some magic

The situation: A group of about 30 people suffers a smallpox outbreak.  They're relatively isolated from other people (though clearly not isolated enough!), and for plot reasons cannot call on anyone for outside assistance.  Food and drink aren't a concern, and a small number of the group (I'm thinking 3 - 4) are immune due to prior exposure.  The magic in this world is low-level stuff.  It's not going to cure anything, just help people survive.

In researching smallpox, I keep seeing variations on this: "Fever develops, then goes down as the rash develops, and patients start to feel better."  And yet, nobody will define "better."  I know that the fever rises again as the rash progresses, but I've also seen references to people with smallpox being very aware of what's happening around them.  Obviously, smallpox is not something where you'll be allowed to wander back to your regular life while still covered in scabs.  My question is, would you be able to do so, once through the first bout of fever?  Can someone with smallpox care for themselves, with little or no help from others?  They'll have smallpox lesions on their hands and feet, but that doesn't actually make someone bedridden.  I had lesions on my feet that I would describe the same way I see smallpox lesions described (hard bumps under the skin), but they didn't hurt to walk on.  They felt weird, but I kept right on with my normal routine (including running regularly).  It's probably just as well I didn't know much about smallpox at that point, or my inner hypochondriac would have had me running for the doctor.  :)

So how helpless will the smallpox victims be, and for how long?  I know what the beginning will be like, and I know what the end will be like (a few deaths, scarring for most of the survivors, some cases of pneumonia, at least one person will have ongoing vision problems), but I cannot for the life of me figure out the middle.  And it's really important to the story, because if all these people are mostly able to go about their normal duties within a few days, then it obliterates some really important character motivation for one of the caretakers.  I know there will be some variation among the victims, depending on the severity, and that anyone with confluent smallpox isn't going to be doing much of anything except slowly dying.

And in the end, should I just stop worrying and handwave it because so few people will know the difference?  It's been a while since anyone actually had first hand experience with this, after all.  I just hate to handwave if I don't have to.

Search Terms: smallpox (and "small pox") with variations on symptoms, treatment, disease course, timeline, progression, recovery time, home care; I also read every page on this community that turned up in a search "smallpox"

I also tried looking for first-hand accounts, or looking for instructions for caretakers, but mostly that just gets me lots of dire warnings about the importance of bleach.

I've looked at the Wikipedia article, some US military sites, NIH, WHO, a slideshow from the Health Protection Agency, and the same slide show from the CDC about seventeen times, with some pictures I really shouldn't have looked at over breakfast.  Yay for photos of someone in the late stages of confluent smallpox.

I've turned up several academic sites, but I'm not a doctor or scientist.  When I had to look up seven of the last ten words in a medical dictionary, I went on to another site.  :)


ETA: Thanks, all!  I love it when the answer I get is the answer I want.
Tags: 1300-1399, uk: history: middle ages, ~medicine: illnesses: infectious (misc)

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