The Demon in the Freezer by Richard Preston

across her face and arms. More red spots began to appear closer to her middle, following the movement of the creeping flush. She was forbidden to have any visitors, and there were no telephones at Wimbern that the patients could use. She couldn’t speak with her family.
    The red spots began to enlarge, and there were more and more of them. They began to join together, like raindrops falling on a dry sidewalk, gradually darkening the pavement: she was starting to flood with hemorrhages beneath the skin.
    Her back hurt, but the change in her skin was painless, and she prayed and tried to remain optimistic. Her skin was growing darker and soft and a little puffy. It was slightly wrinkled, like the skin of an old person.
    The red spots merged and flooded together, until much of her skin turned deep red, and her face turned purplish black. The skin became rubbery and silky smooth to the touch, with a velvety, corrugated look, which is referred to as crêpe-rubber skin. The whites of her eyes developed red spots, and her face swelled up as it darkened, and blood began to drip from her nose. It was smallpox blood, thick and dark. The nursing nuns, who were wearing masks and latex gloves, dabbed gently at her nose with paper wipes and helped her pray.
    Smallpox virus interacts with the victims’ immune systems in different ways, and so it triggers different forms of disease in the human body. There is a mild type of smallpox called a varioloid rash. There is classical ordinary smallpox, which comes in two basic forms: the discrete type and the confluent type. In discrete ordinary smallpox, the pustules stand out on the skin as separate blisters, and the patient has a better chance of survival. In confluent-type ordinary smallpox, which Los had, the blisters merge into sheets, and it is typically fatal. Finally, there is hemorrhagic smallpox, in which bleeding occurs in the skin. Hemorrhagic smallpox is virtually one hundred percent fatal. The most extreme type is flat hemorrhagic smallpox, in which the skin does not blister but remains smooth. It darkens until it can look charred, and it can slip off the body in sheets. Doctors in the old days used to call it black pox. Hemorrhagic smallpox seems to occur in about three to twenty-five percent of the fatal cases, depending on how hot or virulent the strain of smallpox is. For some reason black pox is more common in teenagers.
    The rims of Barbara Birke’s eyelids became wet with blood, while the whites of her eyes turned ruby red and swelled out in rings around the corneas. Dr. William Osler, in a study of black-pox cases at the Montreal General Hospital that he saw in 1875, noted that “the corneas appear sunk in dark red pits, giving to the patient a frightful appearance.” The blood in the eyes of a smallpox patient deteriorates over time, and if the patient lives long enough the whites of the eyes will turn solid black.
    With flat hemorrhagic smallpox, the immune system goes into shock and cannot produce pus, while the virus amplifies with incredible speed and appears to sweep through the major organs of the body. Barbara Birke went into a condition known as disseminated intravascular coagulation (DIC), in which the blood begins to clot inside small vessels that leak blood at the same time. As the girl went into DIC, the membranes inside her mouth disintegrated. The nurses likely tried to get her to rinse the blood out of her mouth with sips of water.
    In hemorrhagic smallpox, there is usually heavy bleeding from the rectum and vagina. In his study, Osler reported that “haemorrhage from the urinary passages occurred in a large proportion of the cases, and was often profuse, the blood coagulating in the chamber pot.” Yet there was rarely blood in the vomit, and somewhat to his surprise Osler noticed that some victims of hemorrhagic smallpox kept their appetites, and they continued to eat up to the last day of life. He autopsied a number of victims of flat hemorrhagic