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THE ARCHAEOLOGICAL RECOVERY OF SMALLPOX VICTIMS IN HAWAII: SCIENTIFIC INVESTIGATION OR PUBLIC HEALTH THREAT? JOSEPH KENNEDY* Introduction As the city of Honolulu continues to grow and modernize, urban archaeology projects have become more prevalent and have brought forth vivid reminders of the islands' past. Recently, I directed the archaeological recovery and relocation of a number of individuals who were interred in a downtown cemetery dedicated to the victims of Hawaii's first smallpox epidemic in 1853. During these activities, several members of my crew posed a reasonable question: Was there a danger that they would be infected with the pox virus after handling the remains? While these queries were sometimes only half-serious, they were almost always accompanied by an unsettled, nervous laughter. As I looked down into the exposed, highdensity grave pits and the mixing of the living and those unfortunate dead, I felt a more serious investigation of this troubling possibility was warranted. Smallpox in History Perhaps the oldest known victim of smallpox was the Egyptian Pharaoh Ramses V. When his mummy was subjected to forensic examination by physicians associated with the World Health Organization in November of 1979, they noticed that a number of yellowish blisters or pustules still covered most of the body. This discovery excited the attention of Dr. Donald Hopkins who wrote, "And after seeing at first hand the rash on this remarkable mummy, I am almost as convinced that he *Archaeological Consultants of Hawaii, 59-624 Pupukea Road, Haleiwa, Hawaii 96712.© 1994 by The University of Chicago. All rights reserved. 0031-5982/94/3704-0879$01.00 Perspectives in Biology and Medicine, 37, 4 ¦ Summer 1994 499 did indeed have smallpox as if I had actually seen a 3,000 year old pox virus" [I]. While this is a strong indication of smallpox infection in dynastic Egypt, this disease was also a problem in other parts of the ancient world. There are literary allusions to a Hindu goddess of smallpox (Slittala mala) and other evidence indicating that the disease was endemic in India since before the time of Christ. China has wrestled with this scourge since 250 b.c. when Huns from Central Asia invaded the northern provinces. A second outbreak in a.d. 48 killed the famous general Ma-Yuan and more than 20,000 of his men near present day Hunan. In the West, the spread of smallpox virus reached epidemic proportions by the time of the Napoleonic Wars. In a span of less than fifty years, the disease had claimed the lives of Mary II of England, Joseph I of Austria, Louis I of Spain, Peter II of Russia, and Ulrika Eleonara of Sweden; Maria Theresa of Austria barely survived, but lost four of her six children to smallpox in the next six years [2]. While the devastation ofroyal blood lines serves as a sensational example of smallpox's effect, there were, of course, thousands of other less famous victims. As the etiology of the disease implies, those most susceptible were the urban poor who were clustered together in conditions custom-tailored for rapid contamination. The advent of any disease epidemic has always been a cause for great concern, but for good reason, an outbreak of smallpox usually occasioned something closer to a genuine panic. Before the development of an effective vaccine, the reasons for this reaction were quite understandable : the contamination factor was very high and the disease spread very quickly; the victim suffered a hideous death and there was no known or accepted cure. It has been said that it is as difficult to witness a death from smallpox as it is to actually suffer it. The tiny Variola major virus works in a most insidious fashion, establishing itself in the lungs where it replicates and produces a primary varemia before invading the lymph glands, spleen, and liver. Once firmly established in its human host, there is a rapid and grotesque degeneration characterized by nausea, fever, convulsions, and delirium. In addition, the body is covered with a rash that in turn blisters, and then becomes scabby pustules. Death relieves the miserable victim only after the onset of acute toxemia or massive hemorrhaging into the skin, lungs, intestines or...