What is Ebola? The Encyclopaedia Britannica describes Ebola
as a “virus (family Filoviridae) responsible for a severe and often fatal
hemorrhagic fever; outbreaks in primates as well as in humans have been recorded. The disease is characterized by extreme
fever, rash, and profuse hemorrhaging.
Fatality rates range from 50 to 90 percent”¹ Obviously, this is a very
potent disease, not to be taken lightly.
The disease and it’s effects
are described in some detail, through the personal experiences of a French naturalist
living in Kenya,
in a book The Hot Zone by Richard
Preston, published in 1994. The book
covers the period 1967 through 1993, and the author has changed the name of the
naturalist to Charles Monet for purposes of the book.²
Ebola and the Marburg virus (1967) are
the only members of the Filoviridae. It
is doubtful that members of the United
States medical community would ever have
occasion to be exposed to this disease either for study or for treatment. Perhaps a thumbnail sketch of what happened
to Charles Monet would help the reader to understand what exposure means to the
patient. What follows is taken from the Preston book without embellishment:
“Ebola Zaire attacks
every organ and tissue in the human body except skeletal muscle and bone. It is a perfect parasite because it
transforms virtually every part of the body into a digested slime of virus particles. The seven mysterious proteins that, assembled
together, make up the Ebola-virus particle, work as a relentless machine, a
molecular shark, and they consume the body as the virus makes copies of
itself. Small blood clots begin to
appear in the bloodstream, and the blood begins to thicken and slows, and the
clots begin to stick to the walls of blood vessels. This is known as pavementing, because the
clots fit together in a mosaic. The
mosaic thickens and throws more clots, and the clots drift through the
bloodstream into the small capillaries, where they get stuck. This shuts off the blood supply to various
parts of the body, causing dead spots to appear in the brain, liver, kidneys,
lungs, intestines, testicles, breast tissue (of men as well as women), and all
through the skin. The skin develops red
spots, called petechaie, 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 the
skin, and hemorrhagic blood flows 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 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 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 that streams 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 creepy, 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 turns 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 convulsions are 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 blood around. Possibly this epileptic splashing of blood is
one of Ebola’s strategies for success – it makes the victim go into a flurry of
seizures as he dies, spreading blood all over the place, thus giving the virus
a chance to jump to a new host – a kind of transmission through smearing.
“Ebola (and Marburg) multiplies so rapidly and powerfully
that the body’s infected cells become crystal-like blocks of packed virus particles. These crystals are broods of virus getting
ready to hatch from the cell. They are
known as bricks. The bricks, or
crystals, first appear near the center of the cell and then migrate toward the
surface. As the crystal reaches a cell
wall, it disintegrates into hundreds of individual virus particles, and the
broodings push through the cell wall like hair and float away in the
bloodstream of the host. The hatched Ebola particles cling to cells everywhere
in the body, and get inside them, and continue to multiply. It keeps on multiplying until areas of tissue
all through the body are filled with crystalloids, which hatch, and more Ebola
particles drift into the bloodstream, and the amplification continues inexorably
until a droplet of the host’s blood can contain a hundred million virus
particles. After death, the cadaver
sudden deteriorates: the internal organs, having been dead or partially dead
for days, have already begun to dissolve, and a sort of shock-related meltdown
occurs. The corpse’s connective tissue,
skin, and organs, already peppered with dead spots, heated by fever, and
damaged by shock, begin to liquefy, and the fluids that leak from the cadaver
are saturated with Ebola-virus particles.”
What has been described above
may be too graphic for some readers, but considering the disease that is the
subject of this paper, better to err on the side of the more graphic
discussion. In the case of Charles
Monet, the author Preston included a brief
description of Monet’s final moments at the Nairobi Hospital.
“…So Charles Monet is sitting
on a bench in Casualty, and he does not look very much different from anyone
else in the room, except for his bruised, expressionless face and his red
eyes.…Monet maintains his silence, waiting to receive attention. Suddenly he goes into the last phase. The human virus bomb explodes. Military biohazard specialists have ways of
describing this occurrence. They say
that the victim has ‘crashed and bled out.’
Or more politely they say that the victim has ‘gone down.’ …[Monet]
becomes dizzy and utterly weak, and his spine goes limp and nerveless and he
loses all sense of balance. The room is
turning around and around. He is going
into shock. He leans over, head on his
knees, and brings up an incredible quantity of blood from his stomach and
spills it onto the floor with a gasping groan.
He loses consciousness and pitches forward onto the floor. The only sound is a choking in his throat as
he continues to vomit while unconscious.
Then comes a sound like a bed sheet being torn in half, which is the
sound of his bowels opening and venting blood from the anus. The blood is mixed with intestinal
lining. He has sloughed his gut. The linings of his intestines have come off
and are being expelled along with huge amounts of blood. Monet has crashed and is bleeding out. The other patients in the waiting room stand
up and move away from the man on the floor, calling for a doctor. Pools of blood spread out around him, enlarging
rapidly. Having destroyed its host, the
agent is now coming out of every orifice, and is ‘trying’ to find a new host.”
What you have just read is
copied from The Hot Zone by Richard
Preston. It describes the Kenya episode
when the disease struck communities near Kilimanjaro. Ebola strikes in one location, goes into
hibernation, and returns in another location.
Why? There are a number of
theories why, but none answer all questions at this time.
² Preston,
Richard. The Hot Zone. New
York, New York:
Random House, Inc., 1994.
Originally prepared in 2001
from the cited and other references, then reviewed and rewritten in 2003.
October 2003
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