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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 miles an hour along the autobahn to a laboratory at the state health department in