House on Fire Read Free Page A

Loathsome Disease
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    You can smell smallpox before you enter the patient’s room, but it’s hard to describe. Even medical textbooks fall short when it comes to smells. The odor, probably the result of decaying flesh from pustules, is reminiscent of the smell of a dead animal. On at least two occasions, smell alone alerted me to the presence of smallpox. As I walked down a hospital hallway in India, the dead-animal odor stopped me in my tracks; following the smell, I located a smallpox patient. Another time, as I walked down an alley in an urban slum in Pakistan, the same smell hit me. There are competing smells in such places, but again one smell stood out. Knocking on doors, I found two siblings with smallpox.
    Today, thirty years after the last recorded case of smallpox on the planet, I still find myself contemplating alternative tactics for its eradication, including one using smell. What if back then we’d been able to use trained dogs to identify smallpox patients? This would have sped up thesearches in urban alleyways and railway stations, where people often lay on the ground, obscured under blankets.
    Those of us working in the worldwide smallpox eradication program in the 1960s and 1970s made countless visits to smallpox patients. Most of these visits were to small, crowded, airless, single-room dwellings with the windows covered. In the dark, we were taken to the patient’s bed, and it was possible, with a penlight, to examine the lesions and estimate the stage of the disease. Early on, the pocks would be surprisingly hard and deep. As the disease developed, they would fill with pus and soften, becoming pustules. Once the pustules began to break down, the mixture of pus and blood would stain the patient’s bed and clothing. The person in the bed might have been happy and productive the previous week, but now had limited prospects of even seeing another day.
    The disease took each of its hosts by surprise. They were not aware that a virus had entered their body and was silently establishing a beachhead by multiplying in the mindless way that viruses do. The virus carried no ill will; it was simply responding to the drive to perpetuate itself. It cannot reproduce on its own; it has to borrow cells from a human being. The borrowed cells put out ever more viruses, which in turn take over other cells.
    Having borrowed and destroyed the cells in order to reproduce, the virus shows its gratitude, as it were, by wreaking havoc on its host. After two weeks of multiplication, just when the immune system is organizing a defense, the virus’s host for the first time realizes something is wrong—a fever, a headache, perhaps a backache and vomiting. We all experience such symptoms occasionally, so the host doesn’t worry. But after another two days, there is no denying the truth. The throat is sore because of lesions on the mucous membranes, and red bumps have appeared on the skin, especially on the face, arms, and legs. Over the next few days, the bumps turn to pustules. A robust immune system and a strong constitution might, at this point, turn the tide against the virus, and the host will recover. Even so, for most survivors, the price is high: pockmarks or even permanent blindness. Many, however, are unable to develop sufficient defenses; they die.
    We saw some patients who didn’t live long enough to develop pustules. The skin became swollen, the fever was high, and the patient became toxic. The virus completely overwhelmed the immune system.The patient began to bleed with a hemorrhagic version of the disease that led, mercifully, to an early death.
    Once the virus had left the host’s body in absolute chaos, it sought out a new host to repeat the process. To me, the process made no sense—what was the purpose? What was the meaning? But the reality of nature seems to be that some species provide no evident benefit to the community of living organisms.
    While