The Hot Zone by Richard Preston Page B

through the skin. The skin develops red spots, called petechiae, which are hemorrhages under the skin. Ebola attacks connective tissue with particular ferocity; it multiplies in collagen, the chief constituent protein of the tissue that holds the organs together. (The seven Ebola proteins somehow chew up the body’s structural proteins.) In this way, collagen in the body turns to mush, and the underlayers of the skin die and liquefy. The skin bubbles up into a sea of tiny white blisters mixed with red spots known as a maculopapular rash. This rash has been likened to tapioca pudding. Spontaneous rips appear in theskin, and hemorrhagic blood pours from the rips. The red spots on the skin grow and spread and merge to become huge, spontaneous bruises, and the skin goes soft and pulpy, and can tear off if it is touched with any kind of pressure. Your mouth bleeds, and you bleed around your teeth, and you may have hemorrhages from the salivary glands—literally every opening in the body bleeds, no matter how small. The surface of the tongue turns brilliant red and then sloughs off, and is swallowed or spat out. It is said to be extraordinarily painful to lose the surface of one’s tongue. The tongue’s skin may be torn off during rushes of the black vomit. The back of the throat and the lining of the windpipe may also slough off, and the dead tissue slides down the windpipe into the lungs or is coughed up with sputum. Your heart bleeds into itself; the heart muscle softens and has hemorrhages into its chambers, and blood squeezes out of the heart muscle as the heart beats, and it floods the chest cavity. The brain becomes clogged with dead blood cells, a condition known as sludging of the brain. Ebola attacks the lining of the eyeball, and the eyeballs may fill up with blood: you may go blind. Droplets of blood stand out on the eyelids: you may weep blood. The blood runs from your eyes down your cheeks and refuses to coagulate. You may have a hemispherical stroke, in which one whole side of the body is paralyzed, which is invariably fatal in a case of Ebola. Even while the body’s internal organs are becoming plugged with coagulated blood, the blood thatstreams out of the body cannot clot; it resembles whey being squeezed out of curds. The blood has been stripped of its clotting factors. If you put the runny Ebola blood in a test tube and look at it, you see that the blood is destroyed. Its red cells are broken and dead. The blood looks as if it has been buzzed in an electric blender.
    Ebola kills a great deal of tissue while the host is still alive. It triggers a creeping, spotty necrosis that spreads through all the internal organs. The liver bulges up and turns yellow, begins to liquefy, and then it cracks apart. The cracks run across the liver and deep inside it, and the liver completely dies and goes putrid. The kidneys become jammed with blood clots and dead cells, and cease functioning. As the kidneys fail, the blood becomes toxic with urine. The spleen turns into a single huge, hard blood clot the size of a baseball. The intestines may fill up completely with blood. The lining of the gut dies and sloughs off into the bowels and is defecated along with large amounts of blood. In men, the testicles bloat up and turn black-and-blue, the semen goes hot with Ebola, and the nipples may bleed. In women, the labia turn blue, livid, and protrusive, and there may be massive vaginal bleeding. The virus is a catastrophe for a pregnant woman: the child is aborted spontaneously and is usually infected with Ebola virus, born with red eyes and a bloody nose.
    Ebola destroys the brain more thoroughly than does Marburg, and Ebola victims often go into epileptic convulsions during the final stage. The convulsionsare generalized grand mal seizures—the whole body twitches and shakes, the arms and legs thrash around, and the eyes, sometimes bloody, roll up into the head. The tremors and convulsions of the patient may smear or splatter