While smallpox was primarily a medical disease, surgical intervention was occasionally documented for its severe complications, particularly before antibiotics. The most common scenarios involved secondary bacterial infections. The deep skin lesions could become gateways for pathogens like streptococcus or staphylococcus, leading to:
Abscesses and Cellulitis: Surgeons performed incision and drainage procedures when pus collected beneath the hard eschars (scabs), a painful condition requiring lancing to relieve pressure and prevent systemic spread.
Gangrene and Necrosis: In severe cases, blood supply to affected skin and underlying tissues could be compromised, leading to gangrene. Surgical debridement—cutting away dead tissue—was necessary to save surrounding healthy tissue, a high-risk procedure in the pre-antiseptic era.
Orthopedic Complications: Septic arthritis occasionally occurred if the infection spread to joints, potentially requiring surgical drainage or even amputation to control overwhelming sepsis.
Ophthalmic Interventions: For survivors with corneal scarring and blindness, early (if crude) attempts at corneal surgery or procedures to correct eyelid deformities caused by scarring were documented in the 19th century.