Hemorrhagic Smallpox

The rarest and most lethal form of smallpox

Hemorrhagic Smallpox Rash, photo by J. B. Byles in Thomas Francis Ricketts, The Diagnosis of Smallpox
(London and New York: Cassell and Co., 1908)

• Susceptibility ran in families and may therefore be genetic.
• For unknown reasons, pregnant women were also at high risk.
• There were two types:

 
Early Hemorrhagic Smallpox

• 100% fatal
• The rash presented as a thick, velvety reddish-purple layer, giving this form of the disease its old folk-name: The Purples.
• Victims died on or about the sixth day after the onset of symptoms, before blisters ever broke out.
• The immediate cause of death was heart failure or pulmonary edema (fluid in the lungs).

 
Late Hemorrhagic or “Flat” Smallpox

• About 97% fatal
• The pustules sank deep into the skin, rather than rising, and were ringed by dark circles (from internal bleeding).
• Victims bled at nose, eyes, vagina, and anus. Old descriptions tell of victims weeping, peeing, and shitting blood.

 
For other forms of the disease, see my posts on Smallpox, the ‘Speckled Monster’, The Course of the Disease, and Confluent Smallpox (WARNING: the latter 2 posts contain graphic images of the disease).