Smallpox: disease progression after rash develops

[sleightly]

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

Comments

[quatorze]

Even if it's just a mild case, patients are highly unlikely to be up and about within a few days looking after themselves, let alone looking after others. Just a look at the Wikipedia article (to refresh my memory) was enough to point out quite a few problems with that scenario:

- "High fever, muscle pain, malaise": A few days of just these symptoms, and you'll definitely need time to recover before you're back on your tottery legs once more. Fever affects people in different ways, but if it gets high enough you're light-headed, possibly delirious, can't sleep, etc. Then there's muscle pain and muscle pain, from just a mild ache to so severe you can hardly breathe.

- "As the digestive tract is commonly involved, nausea and vomiting and backache often occur." So in addition to being in pain and having high fever the patient probably isn't able to eat or drink much of anything for days, which just makes things worse. Not to mention that this complicates administering any medicines that need to be taken orally.

- "...the first visible lesions-small reddish spots called enanthem-appear on mucous membranes of the mouth, tongue, palate, and throat, and temperature falls to near normal." Already a few days of the above symptoms will render the patient pretty weak. Then add lesions in the MOUTH, and that will make swallowing anything at least difficult, possibly very painful or nearly impossible. Not a good thing at this point!

Also, I think you're underestimating the effect of the lesions. Sources say that in smallpox they are definitely painful, so if you have them all over your body you're not just hurting and weak, you cannot really get comfortable or painless in any position. Just try to imagine how exhausting and debilitating that is, on top of everything else.

Then, after the patient has survived all this and reaches the stage where the lesions begin to heal, there's always the risk of the sores getting infected with something different and potentially life-threatening. So, no, getting smallpox isn't comparable to having a little bit of fever and some rash for a few days!

[sleightly]

Which is what I assumed when I wrote the first draft of the novel, but as I've been revising, I went looking for more details, and stumbled on this "and then the patient feels better" crap. Wait, what? And then I kept finding the same thing other places, without any explanation for what, exactly, got better. Gah! Most sites just wanted to tell me how to diagnose smallpox (with lots of time spent on differential diagnoses) and then show me pictures of the stages, without actually telling me what it feels like on the patient's end.

Well, except for the confluent smallpox cases, but it's not all that shocking that having your skin slough off would be painful. What about everybody else??? Especially since, six slides back, the same presentation told me that the patient started feeling better right about the time the rash appeared. Does that mean all the other symptoms (backache, nausea, etc) also went away or diminished? There's a big difference (at least for the caretakers) between laid out for five days versus laid out for twenty days.

Can you tell I got a little frustrated with all these websites? :) I've also realized, in reading the comments here, that I never tried to Google, "Do smallpox lesions hurt?" Not sure how I overlooked it, but that's one of the pieces of information I couldn't find. And it matters!

Anyway, done rambling now. Thanks for the info!

[quatorze]

Yeah, researching things can get frustrating! :) I'm not a medical professional or anything, just took a look at what the Wikipedia article told me, then drew on my own experiences of when I've been ill with something and went on from there to list how the various symptoms would affect the patients. Glad to have been of some help!

[sleightly]

"...drew on my own experiences of when I've been ill with something and went on from there..."

This is problematical for me, though, and why I'm always very cautious of making assumptions about illnesses. When I get sick, I don't feel as bad as I "should." I had an "Oh my god, why didn't you go to the hospital, are you crazy??" fever once, and was still up and moving around, taking care of myself. I didn't feel great, but I wasn't flat on my back, either. I do stuff like this a lot, so I can't ever be sure whether my reaction to a particular symptom is a good baseline.

(This sounds like it would be great, but trust me, it isn't. I'm still sick, but because I don't feel sick, I don't rest the way I should, so I end being medium-grade sick for forever.)