Having been professionally obsessed with smallpox for years, Peter Jahrling couldn’t help thinking about what would happen if a loose pinch of dried variola virus had found its way into the letter to Senator Daschle. We don’t really know what is in that powder, he said to himself. What if it’s a Trojan horse? Anthrax does not spread as a contagious disease—you can’t catch anthrax from someone who has it, even if the victim coughs in your face—but smallpox could spread through North America like wildfire. Jahrling wanted someone to look at the powder, and fast. He picked up his telephone and called the office of a microscopist named Tom Geisbert, who worked on the second floor. He got no answer.
TOM GEISBERT drove in that morning from Shepherdstown, West Virginia, where he lives, and arrived at the USAMRIID parking lot around seven o’clock. He was driving a beat-up station wagon with dented doors and body rust and an engine that had begun to sound like an outboard motor. He had a new pickup truck with a V-8, but he drove the clunker to save money on gas. Geisbert, who was then thirty-nine years old, grew up around Fort Detrick. His father, William Geisbert, had been the top building engineer at USAMRIID and had specialized in biohazard containment. Tom became an electron microscopist and a space-suit researcher. Geisbert is an informal, easygoing person, with shaggy, light brown hair, blue eyes, rather large ears, and an athletic frame. He likes to hunt and fish. He usually wears blue jeans and snakeskin cowboy boots; in cold weather, he’ll have on a cable-knit sweater.
Geisbert went up a dingy stairwell to his office on the second floor of Rid. The office is small but comfortable, and it has one of the few windows in the building, which gives him a view across a rooftop to the slopes of Catoctin Mountain. He sat at his desk, starting to get his mind ready for the day. He was thinking about a cup of coffee and maybe a chocolate-covered doughnut when Peter Jahrling barged in, looking upset, and closed the door. “Where the heck have you been, Tom?”
Geisbert hadn’t heard anything about the anthrax letter. Jahrling explained and said that he wanted Geisbert to look at the powder using an electron microscope, and to do it immediately. “You want to look for anything unusual. I’m concerned that this powder could be laced with pox. You also want to look for Ebola-virus particles. If it’s got smallpox in it, everybody’s going to go around saying, ‘Hey, it’s anthrax,’ and then ten days later we have a smallpox outbreak in Washington.”
Geisbert forgot about his doughnut and coffee. He went downstairs to some windows that look in on suite AA3, where John Ezzell was still working with the Daschle letter. Geisbert banged on the window and got his attention. Speaking through a port in the glass, he asked if he could have a bit of the powder to look at.
THE DREAMING DEMON
The Man in Room 151
EARLY 1970
ON THE LAST DAY of December 1969, a man I will call Peter Los arrived at the airport in Düsseldorf, West Germany, on a flight from Pakistan. He had been ill with hepatitis in the Civil Hospital in Karachi and had been discharged, but he wasn’t feeling well. He was broke and had been holed up in a seedy hotel in a Karachi slum. His brother and father met him at the airport—his father was a supervisor in a slaughterhouse near the small city of Meschede, in the mountains of North-Rhine Westphalia, in northern Germany.
Peter Los was twenty years old, a former apprentice electrician with no job who had been journeying in pursuit of dreams that receded before him. He was tall and good-looking—thin now—with a square, chiseled face and dark, restless, rather guarded eyes under dark eyelashes. He had short, curly hair, and he wore faded jeans. He was traveling with a backpack, in which he’d tucked brushes, pencils, paper, and a set of watercolor paints, and he carried a folding easel.
Peter Los is alive today in Germany. The details of his character have been forgotten by the experts, but his case and its aftermath haunt them like the ruins of a fire.
Los had been living in a commune in the city of Bochum while he studied to be an electrician, but the members of the commune had split ideologically. Some favored a disciplined approach to communal living, while others, including Peter, favored the hippie ideals of the sixties. In August 1969—the month of the Woodstock music festival—eight members of the Bochum commune, including Peter, packed themselves into a Volkswagen bus and set off for Asia on an Orientreise. There were six men and two women on the bus, and they were apparently hoping to find a guru in the monasteries of the Himalayas, where they could meditate and seek a higher knowledge, and possibly also find good hashish. They drove the bus down through Yugoslavia to Istanbul, crossed Turkey, and went through Iraq and Iran, camping out under the stars or staying in the cheapest places. They rattled across Afghanistan on the world’s worst roads, and the Volkswagen bus made it over the Khyber Pass. They hung out in Pakistan, but things didn’t go as well as they had hoped, and they didn’t connect with a guru. The two women lost interest in the trip and went back to Germany, and toward December, three men in the group drove the Volkswagen into India and down the coast to Goa, to attend a hippie festival called the Christmas Paradise. Peter stayed behind in Karachi, and ended up languishing with hepatitis in the Civil Hospital.
An eastbound train took Peter and his father and brother out of Düsseldorf, and traveled through the industrial heart of northern Germany, past seas of warehouses and factories made of brown brick. It is unlikely that Peter would have had much to say to his father at this point. He would have lit a cigarette and looked out the window. The train arrived at the Ruhr River, and it followed the course of the river into the fir-clad mountains of the Sauerland, winding upstream under skies the color of carbon steel, until it reached Meschede.
Meschede is a cozy place, where people know one another. It nestles in a valley at the headwaters of the Ruhr, beside a lake. It had been snowing in Meschede, and the hills and mountains surrounding the city were cloaked in snowy firs. It was New Year’s Eve. Peter and his family celebrated the new decade, and he caught up with old friends and rested, recovering from his illness.
The weather was cloudy and dark, but in the second week of January the clouds broke away from the mountains, and clear air poured down from the north, bringing dry cold and blue skies. At the same time, influenza broke out in the town, and many people became sick with coughs and fevers. Around Friday, January 9th, Peter began to feel strange.
He was tired, achy, restless, and by the end of the day he was running a temperature. Then, on Saturday, his fever spiked upward, and he was very sick in the night. On Sunday morning, his family called an ambulance, and he was taken to the largest hospital in town, the St. Walberga Krankenhaus. He brought his art supplies and his cigarettes with him.
Dr. Dieter Enste examined Peter. He was recovering from his hepatitis, but perhaps he had typhoid fever, which is contagious, and which he could have caught in the hospital in Pakistan. They placed him in the isolation ward, in a private room, Room 151, and they started him on tetracycline.
The St. Walberga Hospital was staffed by the Sisters of Mercy, who served as nurses. The hospital was spare, simple, neat, and spotlessly clean. The isolation ward took up the entire first floor of the south wing, which was a semidetached building, three stories tall, covered with brown stucco, with a staircase that ran through the middle. The nuns told Peter to keep his door closed and not to leave his room for any reason.
He settled in on that Sunday morning and quickly began to feel better, and his fever almost went away. Even so, the nuns forbade him to leave the room, not even to use the bathroom, though it was directly across the hall. They made him use a bedpan, and they emptied it for him, and he washed himself at the sink in his room. The steam radiator under the window hissed and banged, and it made his room feel stuffy. He wanted a cigarette. He slid open one of the room’s casement windows just a crack, got out his cigarettes, and lit one. The nuns were not happy with that, and ordered him to keep his window closed.
That Sunday, a Benedictine priest named Father Kunibert made rounds through the hospital, o
ffering holy communion to the sick. He was an older man, not strong on his legs, and he worked his way down through the building, so that he wouldn’t have to climb stairs. On the first floor at the end of the corridor, he put his head in Room 151 and asked the patient if he wished to receive communion. The young man was not interested. The medical report informs us that he “refused communion” and that “the priest was advised that his services were not desired.”
When the nuns weren’t looking, Peter continued to smoke, with his window open a crack. Cold air would pour in, filling the room with a brisk scent of the outdoors mixed with chirps of sparrows.
The tetracycline wasn’t working, so the doctors started him on chloramphenicol. He had a sense of creeping malaise, an anxious feeling that things weren’t right, that the drugs weren’t working on his typhoid. He was restless, couldn’t get comfortable, and he took out his colors and his brushes and began to paint. When he became tired of that, he sketched with a pencil. There wasn’t much to see out his window—a nursing sister in a white habit hurrying down a walkway, patches of snow, branches of bare beech trees crisscrossing a sky of cobalt blue.
MONDAY AND TUESDAY PASSED. Every now and then a nun would come in and collect his bedpan. His throat was red, and he had a cough, which was getting worse. The back of his throat developed a raw feeling, and he sketched and painted. At night, he may have suffered from dreadful, hallucinatory dreams.
The inflamed area in his throat was no bigger than a postage stamp, but in a biological sense it was hotter than the surface of the sun. Particles of smallpox virus were streaming out of oozy spots in the back of his mouth and were mixing with his saliva. When he spoke or coughed, microscopic infective droplets were being released, forming an invisible cloud in the air around him. Viruses are the smallest forms of life. They are parasites that multiply inside the cells of their hosts, and they cannot multiply anywhere else. A virus is not strictly alive, but it is certainly not dead. It is described as a life-form. There was a cloud of amplified virus hanging in Room 151, and it was moving through the hospital. On Wednesday, January 14th, Peter’s face and forearms began to turn red.
Stripper
JANUARY 15, 1970
THE RED AREAS spread into blotches across Peter Los’s face and arms, and within hours the blotches broke out into seas of tiny pimples. They were sharp feeling, not itchy, and by nightfall they covered his face, arms, hands, and feet. Pimples were rising out of the soles of his feet and on the palms of his hands, and they were coming up in his scalp and in his mouth, too. During the night, the pimples developed tiny, blistery heads, and the heads continued to grow larger. They were rising all over his body, at the same speed, like a field of barley sprouting after rain. They were beginning to hurt dreadfully, and they were enlarging into boils. They had a waxy, hard look, and they seemed unripe. His fever soared abruptly and began to rage. The rubbing of pajamas on his skin felt like a roasting fire. He was acutely conscious and very, very scared. The doctors didn’t know what was wrong with him.
By dawn on Thursday, January 15th, his body had become a mass of knob-like blisters. They were everywhere, all over, even on his private parts, but they were clustered most thickly on his face and extremities. This is known as the centrifugal rash of smallpox. It looks as if some force at the center of the body is driving the rash out toward the face, hands, and feet. The inside of his mouth and ear canals and sinuses had pustulated, and the lining of the rectum may also have pustulated, as it will do in severe cases. Yet his mind was clear. When he coughed or tried to move, it felt as if his skin were pulling off his body, that it would split or rupture. The blisters were hard and dry, and they didn’t leak. They were like ball bearings embedded in the skin, with a soft, velvety feel on the surface. Each pustule had a dimple in the center. They were pressurized with an opalescent pus.
The pustules began to touch one another, and finally they merged into confluent sheets that covered his body, like a cobblestone street. The skin was torn away from its underlayers across much of his body, and the pustules on his face combined into a bubbled mass filled with fluid, until the skin of his face essentially detached from its underlayers and became a bag surrounding the tissues of his head. His tongue, gums, and hard palate were studded with pustules, yet his mouth was dry, and he could barely swallow. The virus had stripped the skin off his body, both inside and out, and the pain would have seemed almost beyond the capacity of human nature to endure.
When the Sisters of Mercy opened the door of his room, a sweet, sickly, cloying odor drifted into the hallway. It was not like anything the medical staff at the hospital had ever encountered before. It was not a smell of decay, for his skin was sealed. The pus within the skin was throwing off gases that diffused out of his body. In those days, it was called the foetor of smallpox. Doctors today call it the odor of a cytokine storm.
Cytokines are messenger molecules that drift in the bloodstream. Cells in the immune system use them to signal to one another while the immune system mounts a response to an attack by an invader. In a cytokine storm, the signaling goes haywire, and the immune system becomes unbalanced and cracks up, like a network going down. The cytokine storm becomes chaotic, and it ends with a collapse of blood pressure, a heart attack, or a breathing arrest, along with a stench coming through the skin, like something nasty inside a paper bag. No one is certain what happens in the cytokine storm of smallpox. The virus is giving off unknown proteins that jam the immune system and trigger the storm, like jamming radar, which allows the virus to multiply unhindered.
In 1875, Dr. William Osler was the attending physician in the smallpox wards of the Montreal General Hospital. He called the agent that caused the sweet smell of smallpox a “virus,” which is the Latin word for poison. In Osler’s day, no one knew what a virus was, but Osler knew the smell of this one. When there were few or no pustules on the skin, he would sniff at a patient’s wrists and forehead, and he could smell the foetor of the virus, and it helped him nail down the diagnosis.
Around midday on Thursday, January 15th, five days after Peter Los had been admitted to the hospital, the doctors began to suspect that he had die Pocken—smallpox. Smallpox causes different forms of disease in the human body. Peter had classical ordinary smallpox.
The scientific name for smallpox is variola, a medieval Latin word that means “blotchy pimples.” The name was given to the disease around A.D. 580 by Bishop Marius of Avenches, in the Vaud region of Switzerland. The English doctor Gilbertus Anglicus described the basic forms of smallpox disease in 1240. The virus is an exclusively human parasite. Smallpox virus can naturally infect only Homo sapiens. It comes in two natural subspecies, variola minor and variola major. Minor is a weak strain that was first identified by doctors in Jamaica in 1863, and is also called alastrim. While it causes people to pustulate, for some reason it rarely kills. Variola major kills around twenty to forty percent of infected humans who are not immune to it, depending on the circumstances of the outbreak and how virulent, or hot, the strain is. As a generality, doctors say that smallpox kills one out of three people.
Virus particles are also known as virions. Smallpox virions are very small. About one thousand of them would span the thickness of a human hair. It may be that you can catch smallpox if you inhale three to five infectious virions, or particles. No one knows the infectious dose of smallpox, but experts believe it is quite small.
Dieter Enste and the other doctors had not considered the idea that Peter Los might have smallpox because the young man had no rash for several days, and he had gotten a vaccination just before he had left Germany. He had gotten a second vaccination when he was in Turkey, but his vaccinations had not taken—he had not developed a scar on his arm, which meant that he had not become immune.
The St. Walberga doctors took a scalpel, cut a pustule on his skin, and drained a little of the opalescent pus onto a swab. They put it in a test tube, and a state official got in a Mercedes and drove the pus at a hundred and twenty mile
s an hour along the autobahn to a laboratory at the state health department in Düsseldorf.
Microscope
JANUARY 16, 1970
KARL HEINZ RICHTER was a smallpox expert in the Düsseldorf office of the state health department, a medical doctor with a kindly face and a flop of hair on one side. He wore stylish metal-framed eyeglasses and a gray sweater under a jacket, which gave him a comfy but up-to-date look. Dr. Richter, along with a team of doctors and technicians, analyzed the pus taken from Peter Los’s skin. They put a little dried flake of the pus in an electron microscope—a tubelike instrument, six feet tall—which could magnify an image up to twenty-five thousand times. Then they took turns looking into the viewing hood; they would have to vote on the diagnosis.
Dr. Richter saw a vista of exploded human skin cells. Mixed in with the cellular debris were thousands of small, rounded bodies that looked like beer kegs. Some experts refer to them as bricks. The view in the microscope seemed vast, for magnified twenty-five thousand times, the flake of pus would have been an object nearly the size of a football field, and the little bricks in it lumps the size of raisins, and there could have been hundreds of thousands of them in the flake. These were virions of a poxvirus, and the vote was unanimous: this was smallpox.