smallpox and found that, in some cases, the linings of the stomach and the upper intestine were speckled with blood blisters the size of beans, but the blisters did not rupture.
At the biocontainment unit at Wimbern, the victim’s deterioration occurred behind the chain-link fence, in a room out of sight. Dr. Paul Wehrle may have visited her (he thinks not), but there was nothing he could have said to her that would have helped, and nothing any doctor could do for her. He had seen hundreds of people dying of hemorrhagic smallpox, and he no longer felt there was any medical distinction among types and subtypes of the bloody form, that it was all an attempt by doctors to impose a scheme of order on something that was just a mess. By the time I spoke with him, the cases had flowed together in his mind, and he felt there was an inexorable sameness in the patients as the bleeding and shock came on. “It was perfectly horrifying,” he said.
Barbara Birke remained alert and conscious nearly up to the end, which came four days after the first signs of rash appeared on her body. For some reason, variola leaves its victims in a state of wakefulness. They see and feel everything that’s happening. In the final twenty-four hours, people with hemorrhagic smallpox will develop a pattern of shallow, almost imperceptible breaths, followed by a deep intake and exhalation, then more shallow breaths. This is known as Cheyne-Stokes breathing, and it can indicate bleeding in the brain. She prayed, and the nuns stayed with her. The Benedictine priest, Father Kunibert, who had offered communion to Peter Los, ended up at Wimbern himself with a mild case of smallpox. He may have given Birke her last rites. As the end approaches, the smallpox victim can remain conscious, in a kind of frozen awareness—“a peculiar state of apprehension and mental alertness that were said to be unlike the manifestations of any other disease,” in the words of the Big Red Book. As the cytokine storm devolves into chaos, the breathing may end with a sigh. The exact cause of death in fatal smallpox is unknown to science.
PEOPLE WHO are coming down with smallpox often exhibit a worried look, known as the “anxious face of smallpox.” A five-year-old girl named Rialitsa Liapsis, who came from a Greek family living in Meschede, got a worried look and broke with severe pustulation in the Wimbern isolation unit. She had been in a room at St. Walberga diagonally across the hall from Peter Los, suffering from meningitis, though she had never seen Los’s face. Rialitsa spent eight weeks recovering from smallpox in the Wimbern unit, sobbing every day for her parents, who were forbidden to see her. The little girl shared her room with Magdalena Geise, a nursing student who had worked on the second floor and had never seen Los but had broken with severe ordinary smallpox. On the day after Barbara Birke died, Magdalena Geise lost her memory completely and blanked out for three weeks. Finally, as her scabs fell off and her mind returned, she did her best to comfort the scared little girl who was crying in the bed on the other side of the room. She did all she could for Rialitsa Liapsis. Magdalena was in Wimbern for twelve weeks, longer than anyone else, and when she emerged she had gone bald, and her face, scalp, and body were a horrendous mass of smallpox scars. She returned to work as a student nurse in the hospital, and wore a wig, but the patients were frightened by her appearance, and the doctors finally had to take her off the ward. A year later, Magdalena Geise’s hair began to grow back, but it would take her ten years to get over her feelings of embarrassment about her appearance. Her religious faith helped her. Eventually, she married, had children and grandchildren, and found deep happiness and fulfillment. Her appearance today is that of a normal middle-aged woman with no disfigurement. Rialitsa Liapsis grew up and had children, and today the two women are
At the biocontainment unit at Wimbern, the victim’s deterioration occurred behind the chain-link fence, in a room out of sight. Dr. Paul Wehrle may have visited her (he thinks not), but there was nothing he could have said to her that would have helped, and nothing any doctor could do for her. He had seen hundreds of people dying of hemorrhagic smallpox, and he no longer felt there was any medical distinction among types and subtypes of the bloody form, that it was all an attempt by doctors to impose a scheme of order on something that was just a mess. By the time I spoke with him, the cases had flowed together in his mind, and he felt there was an inexorable sameness in the patients as the bleeding and shock came on. “It was perfectly horrifying,” he said.
Barbara Birke remained alert and conscious nearly up to the end, which came four days after the first signs of rash appeared on her body. For some reason, variola leaves its victims in a state of wakefulness. They see and feel everything that’s happening. In the final twenty-four hours, people with hemorrhagic smallpox will develop a pattern of shallow, almost imperceptible breaths, followed by a deep intake and exhalation, then more shallow breaths. This is known as Cheyne-Stokes breathing, and it can indicate bleeding in the brain. She prayed, and the nuns stayed with her. The Benedictine priest, Father Kunibert, who had offered communion to Peter Los, ended up at Wimbern himself with a mild case of smallpox. He may have given Birke her last rites. As the end approaches, the smallpox victim can remain conscious, in a kind of frozen awareness—“a peculiar state of apprehension and mental alertness that were said to be unlike the manifestations of any other disease,” in the words of the Big Red Book. As the cytokine storm devolves into chaos, the breathing may end with a sigh. The exact cause of death in fatal smallpox is unknown to science.
PEOPLE WHO are coming down with smallpox often exhibit a worried look, known as the “anxious face of smallpox.” A five-year-old girl named Rialitsa Liapsis, who came from a Greek family living in Meschede, got a worried look and broke with severe pustulation in the Wimbern isolation unit. She had been in a room at St. Walberga diagonally across the hall from Peter Los, suffering from meningitis, though she had never seen Los’s face. Rialitsa spent eight weeks recovering from smallpox in the Wimbern unit, sobbing every day for her parents, who were forbidden to see her. The little girl shared her room with Magdalena Geise, a nursing student who had worked on the second floor and had never seen Los but had broken with severe ordinary smallpox. On the day after Barbara Birke died, Magdalena Geise lost her memory completely and blanked out for three weeks. Finally, as her scabs fell off and her mind returned, she did her best to comfort the scared little girl who was crying in the bed on the other side of the room. She did all she could for Rialitsa Liapsis. Magdalena was in Wimbern for twelve weeks, longer than anyone else, and when she emerged she had gone bald, and her face, scalp, and body were a horrendous mass of smallpox scars. She returned to work as a student nurse in the hospital, and wore a wig, but the patients were frightened by her appearance, and the doctors finally had to take her off the ward. A year later, Magdalena Geise’s hair began to grow back, but it would take her ten years to get over her feelings of embarrassment about her appearance. Her religious faith helped her. Eventually, she married, had children and grandchildren, and found deep happiness and fulfillment. Her appearance today is that of a normal middle-aged woman with no disfigurement. Rialitsa Liapsis grew up and had children, and today the two women are
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