After two or three days of illness, pains of extraordinary severity develop. The head feels as though the skull is opening and shutting. Excruciating backache feels like the bones grinding together. There is complete prostration but also persistent sleeplessness and an unnatural clearness of intellect - as though none of these sufferings should be missed. The breath has a sickly odour, 'unique in the catalogue of nasty smells' according to T.F. Ricketts's Diagnosis of Smallpox (1908) - Ricketts was medical superintendent of the Smallpox Hospitals and River Ambulance Service of the Metropolitan Asylums Board. The haemorrhagic rash matures on the tenth day; death occurs about this time.

LRB 5 September 2002 | PDF Download