Harry Truman was president, the term “Cold War” gained national prominence and the Cincinnati Reds were in the midst of a dismal season.

        It was the summer of 1948, the first time in nearly three decades the city lost a person to smallpox. And according to local health records, the death was likely Cincinnati's last from the disease.

        As worldwide fear of potential bioterrorist attacks spreads in the wake of Sept. 11, the story of one South Fairmount man's death can show Cincinnati what might happen if there were an outbreak.

        “The interesting thing from my perspective about this case is that it was effectively controlled,” said Malcolm Adcock, Cincinnati's health commissioner and an expert on bioterrorism. “And the methods they used are some of the same methods being suggested today.”

        In 1980, the World Health Organization declared smallpox globally eradicated, with one spokesman going so far as to say, “There is no chance smallpox will return.”

        But speculation and concern have begun to build recently both among political and health officials over whether the virus may exist in labs other than the two designated by the WHO.

        “There is no evidence that we know of of a credible threat, of a planned attack using smallpox against the United States,” said Curtis Allen, a spokesman for the federal Centers for Disease Control and Prevention.

        But there are rumors that countries may have stolen stockpiles of the virus, he said.

        “We are basing our preparedness on rumors and rumors of rumors,” Mr. Allen said.

        If terrorists were to somehow spread a communicable disease, health authorities would turn to the same methods used in Cincinnati in 1948 to thwart an outbreak, including vaccination and isolation.

        The CDC released an update of its smallpox response plan in November, which includes such strategies as ring vaccination — or monitoring and vaccinating a “ring” of people around each confirmed case.

        “It is an extension, an adaptation of what was used to eradicate smallpox years ago,” Mr. Allen said.

1948 headlines

        The flurry over the 1948 incident began on a summer day in July when two nephews of a quiet bachelor on the city's west side noticed their uncle sick with something nobody could explain.

        Joseph Horn, 63, had been away from work at the P.R. Mitchell Co. — a business that made bedding and pillows, on Spring Grove and Harrison avenues — where he sterilized feathers, because of a recurrent touch of neuritis.

        But when he broke out in a rash a week later, the doctor's diagnosis was chicken pox.

        “I came home to my dad one day and said, "What's wrong with Uncle Joe,'” said Pete Horn, the man's nephew of Green Township. “His head is all blown up.”

        Mr. Horn, now 66, and his brother Glenn, 72, of Delhi Township, were grade-school students at St. Bonaventure that year when they were instructed by their father to look after Uncle Joe, who lived in a small apartment on Montrose Avenue.

        Joe Horn was a short and stocky fellow who lived in the same house his parents had lived in. He liked to play cards, eat frankfurters on rye bread and drink a pint in the local pubs once in a while, Glenn Horn said.

        But when Uncle Joe got sick, he wasn't himself.

        “His face was all puffed up,” Pete Horn explained. “His eyes were closed and he could barely see. He had red splotches all over. His hands were the same way. He barely talked to me.”

        About two weeks later, Joe Horn went to General Hospital, what now is University Hospital. He had been isolated and was in grave condition.

        The diagnosis wasn't chicken pox at all. It was smallpox. Headlines in newspaper pages read: “Smallpox is feared as man is isolated; First case in years” and “Smallpox patient is dead; Health officers study case, take stringent precautions.”

        But how did he get it? The best theory was that some of the feathers he sterilized at the company — of which he'd been an employee for 35 years — carried the disease. They came from China and all over the world, one report said.

        Smallpox is a disease caused by the Variola virus. It is spread from person to person, usually after the sick person develops a fever and a rash.

        “It does make some degree of sense if he hadn't gone out of the country,” Dr. Adcock said. “It's as plausible an explanation as anything else you'd want to conjure up.”

        The city's public health department did not quarantine anyone but vaccinated 110 people, including Joe Horn's caretakers, neighbors and scores of co-workers, in an exhaustive effort to stop the disease from spreading.

        “Some of the neighbors even made a point, when they found out what it was, that they should go get vaccinated,” Pete Horn said.

        Even still, there was no real understanding of the danger for the two boys.

        “I knew smallpox could kill, but so could pneumonia and being hit by a car,” Glenn Horn said. “When you're that young, you don't have fears.”

Sabin confirms

        Dr. Adcock said because no other cases were reported, that suggests the efforts to control the disease were effective.

        “The good news is that what this case shows us is these kinds of efforts are effective,” he said. “Clearly it was controlled in this case and that's a lesson to be learned.”

        Even before the smallpox tests results were verified by Dr. Albert Sabin — a physician at General Hospital who went on to invent an oral polio vaccine — health officials took serious precautions.

        “My father said they put him in a special casket,” Pete Horn said. “He went right from the funeral home to the cemetery because of his disease, because of the scare that it was so contagious.

        “I think my father was the only one who went to the cemetery.”

        That precaution went even further when health officials told the family they had to burn the furniture and put other personal belongings in an unused cistern in the yard.

        “I said, "Why are we doing this?'” Pete Horn said about a conversation with his father. “He never questioned anybody.”

        Officials from the Ohio Department of Health are now reviewing model legislation from the CDC. It is likely the General Assembly will introduce legislation in 2002 to update state law with regard to outbreaks.

        The CDC sent the legislation to every state to ensure adequate regulations are in place concerning information sharing and quarantines among other things.

        Dr. Michael Auslanger, assistant director of the division of epidemiology in Kentucky's Department for Public Health, said he doesn't expect any changes in commonwealth law.

        “There's not anything in there that looked like we needed to do that we can't already do,” he said.

        History does provide important insight about how an outbreak could be kept under control.

        “We can't absolutely correlate what happened then with what might happen now,” Dr. Adcock said.

        But perspective can help.

        “It would be quite an effort,” he said.

What makes smallpox such a serious threat

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