The Speckled Monster

by Jennifer Lee Carrell

  In essence, doctors destroyed smallpox by destroying its habitat. Like vampires, variola quickly dies in the glare of sunlight; it cannot, under normal circumstances, survive long outside the human body. Using vaccination to turn every vulnerable member of the species into uninhabitable territory, doctors eventually exterminated variola from nature. In April 1978, a World Health Organization field office declared victory in a brief telegram sent winging from Nairobi to headquarters in Geneva: “Search complete. No cases discovered. Ali Maow Maalin is the world’s last known smallpox case.” Maalin had sickened and recovered in Somalia in the fall of 1977, though it would take until May 1980 for the World Health Organization to certify the proclamation of its Kenyan field office. Whichever endpoint you choose, the long war was over.

  As Jonathan Tucker has described in Scourge: The Once and Future Threat of Smallpox, only two samples of the virus are known to survive, deep-frozen in maximum-security prisons in Russia and the United States—prisons that threaten to become Pandora’s boxes.

  Amid celebrations of victory and growing fears of a future breakout, whether accidental or deliberate, the equally dramatic origins of the long fight against smallpox have lingered in the shadows. Edward Jenner, who developed and propounded vaccination in the 1790s, is often credited as the founding father of immunology. But Jenner, more accurately, forced a quantum leap in the fight against smallpox; he did not start it.

  Jenner’s vaccination introduced the cowpox virus (called “vaccinia,” from vacca, Latin for “cow”) into the body through small pricks in the skin, the body’s first and best shield against disease. Though related to smallpox, cowpox is a minor ailment, one most healthy human bodies (as well as healthy bovine bodies) can easily conquer. In mustering troops against vaccinia, however, the body also goes on high alert against its lethal cousin variola, the smallpox virus (whose name derives from the Latin adjective varius, meaning “spotted”). When and if variola tries to sneak into a vaccinated body, it’s killed off before it can establish any strong footing, much less a stranglehold.

  Jenner’s contribution was to find a virus related to, but far less dangerous than smallpox with which to put the body’s immune system on alert. Introducing virus into the skin in order to produce smallpox immunity, though, had already been in practice in the British Empire for seventy-five years: but the old form of inoculation—then called “engrafting” and now called “variolation”—used live smallpox virus. The danger in doing so, of course, was that it could produce full-blown smallpox; patients undergoing inoculation could also spread the disease, triggering an epidemic.

  When variolation worked, it produced no more than a mild case of the disease in a patient kept safely quarantined. Except at the point where the virus had been force-fed into the body, it left no scars. Even this relatively gentle encounter with the disease, though, granted the one great gift of surviving smallpox: complete and permanent immunity.

  Vaccination, on the other hand, put the patient at far less risk of serious complications, and removed altogether the risk of spreading smallpox. It also, however, delivered a lesser gift: temporary and, in some cases, only partial immunity. It was less absolute, but vaccination’s shield would prove to be more than strong enough.

  Before 1798, when Jenner published his first vaccination paper, however, variolation for all its risks was not merely the best, but the only means of protection against smallpox. In the throes of epidemics that could kill as many as one in three victims, and leave many others grotesquely scarred or blinded, the roughly one-in-a-hundred odds of dying from variolation often looked very good.

  Neither Lady Mary nor Boylston invented inoculation; they were crucial catalysts rather than inventors. At the beginning of the eighteenth century, European medicine was helpless against the disease, but loath to admit it. Recognizing that failure, Lady Mary and Boylston were willing to look elsewhere for relief.

  The paradox of using smallpox to fight smallpox was not a product of methodical Western science. Its discovery and development lie hidden in the unrecorded history of the folk medicine of the Middle East, the Caucasus, and Africa. Many people around Lady Mary and Boylston sneered not only at their lack of training, but at their willingness to pay serious attention to rumors coming from even more absurdly “ignorant” sources: Ottoman women and African slaves.

  In the 1720s, Louis Pasteur’s germ theory lay another 140 years in the future, and the mechanisms of disease were as yet little understood. No one knew why inoculation might work; they only gradually became certain that it did work. Observers did know two important facts about smallpox, however. They knew that the disease was virulently contagious, and suspected that it was passed by breathing “bad” air somehow infected by victims, or by the presence of victims’ clothing and bedding. Secondly, it was already common knowledge that those who had survived smallpox were forever after immune: with smallpox, there was no double jeopardy.

  This is a history of long ago, but the quarrels that erupt through this story are still very much with us. Inoculation was controversial for the same reasons that smallpox vaccination remains controversial: it is dangerous—though the degrees of danger are greatly different. In all kinds of inoculation—variolation, vaccination proper (with the vaccinia virus), flu, polio, measles—doctors make patients a little bit sick, at least locally, in order to keep them healthy on the whole. Or so they hope.

  But all vaccinations carry risks: some percentage of patients will have adverse reactions, or prove to have no ability to fight the disease they’ve been exposed to, and will sicken seriously and possibly die. With smallpox vaccination, the risk of death is one or two in a million for primary vaccinations, and one in four million for revaccinations. For variolation, it ranges between one in fifty to one in a hundred. No one, now, is going to say that one-in-fifty odds are an acceptable risk. In a world without smallpox, neither are the one-in-a-million odds of the old vaccine—which is why the United States began phasing it out in 1972.

  But what of a world in which smallpox is a maybe? When that “maybe” could result in a global pandemic that could kill millions within months if not weeks? Precisely how much of a maybe makes the odds of vaccination worthwhile?

  It is one thing to argue about numbers, another entirely to argue about your own children, as both Lady Mary and Boylston discovered.

  In the end, their tale is a history of hope: through the hatred, dying, threats, and shouting there is always visible a defiant will to live, to learn, and to love. That, as much as anything else, is what has made this tale of two heroes and a terrible disease worth the telling.

  How difficult a thing it is, to set Truth in a clear light in this case to the satisfaction of an unbelieving world.

  —Zabdiel Boylston

  I am going to write a history so uncommon that in how plain a manner so ever I relate it, it will have the air of a romance.

  —Lady Mary Wortley Montagu

  PART ONE

  London

  1

  TWO MARYS

  EARLY in December 1694, an assassin emerged from the streets of London to sneak westward across the park, slip unseen through the halls of Kensington Palace, and attack the beautiful and beloved young queen.

  Six years before, it had taken a revolution to put Mary and her Dutch husband, William of Orange, on the British throne, but on this wintry day her attacker was neither counterrevolutionary nor common robber. Nothing more than a tiny protein-coated and exuberantly proliferant tangle of DNA, it was the virus now known as variola major. Its identification would take another two and a half centuries, but in 1694 the disease it triggered was already notorious. “The small pox,” the English called it, to distinguish it from “the great pox,” syphilis, whose strange rashes it sometimes mimicked.

  Silently, without so much as a lone tickle or twinge of warning, the infection burrowed deep into the queen’s body. For almost two weeks, it stayed out of sight, as the virus multiplied in the dark. Meanwhile, Ma
ry seemed to be wrapped safe within the gilt pavilions and cupolas of her favorite pleasure house, its rooms festooned with laughter and music, swept with the rustling of silk, and gleaming with forests of the blue-and-white Chinese porcelain she loved to collect.

  Then, five days before Christmas, fever exploded through her body, chased by intense flashes of pain in her head and back. Without telling anyone she was ill, she dosed herself with her old-faithful cold remedies, but by evening nothing had helped. With a smallpox epidemic raging in London, Queen Mary assumed the worst. She sent everyone who had not already had the disease away from the palace and shut herself in her innermost room. Veering between shivers and sweats, she wrote a last long letter of love and advice to the sometimes wayward king. After locking it in a little drawer in the desk by her bed, she spent the rest of the night burning her diaries and long-treasured letters, preparing to die.

  Three days later, a deep reddish-purple flush crept in uneven patches across her face. Confronted with this rosy fire, the nine physicians who gathered at her bedside looked grim. They knew of two maladies that commonly produced it, and neither was good news.

  “If the queen is lucky,” they intoned among themselves, “it might be measles.” If she were not, they knew but could not yet bear to say, it would turn out to be smallpox.

  The only way to find out was to wait.

  The next day, a cold and blustery Sunday, the ominous blush faded, and blisters began to rise on the queen’s face, arms, hands, and feet. Despite the now inescapable diagnosis of smallpox, the physicians’ hopes rose along with her bubbling rash.

  “At least she does not have the purples,” they told each other with relief. The mere appearance of the blisters canceled out the possibility of that horror: the rare but invariably fatal form of early hemorrhagic smallpox, which made its victims leak blood from every orifice while their bodies swelled beneath skin turned to dark purple velvet, until they died of heart failure—all before a rash of telltale pocks could ever break out.

  “Then she is out of danger?” asked King William.

  But the doctors shook their heads. “That we cannot yet say.”

  The king, who had suffered the disease in childhood and lost both parents to it, broke down and wept. He was a soldier at heart, a daring and some said brilliant commander who relished any threat that action and strategy might answer. He thrilled to direct men through the danger and chance of the battlefield, but as his wife headed into her own private war with smallpox, there was nothing he could do but watch from the far shore of immunity. He set up a camp bed inside Mary’s room and refused to leave her side.

  You can believe what a condition I am in, loving her as I do, he scribbled to a cousin. If I should lose her, I shall have done with the world.

  He was not alone in his fear; nor was the queen. All that day and the next, which was Christmas Eve, courtiers and bishops pressed into the stifling sickroom. Still more milled just outside the door, while less exalted crowds gathered in hushed throngs amid the snow flurries down in Kensington High Street.

  Up in the palace, the doctors held their breath and kept their voices low. Perhaps, after all, the queen would suffer only what they called “kind and distinct” smallpox—the most common and least debilitating form of the disease, in which the pocks remained relatively small and self-contained, resembling a savage case of the chicken pox. Overheard in snatches, the physicians sounded as if they were arguing over a malodorous orchard they both loathed and longed for, producing foully abundant “crops” of “limpid” blisters.

  “You talk like the horned gardeners of hell,” snapped the king. “Are you sure you are doctors?”

  The queen’s blisters, the physicians continued in soothing tones, appeared to be ripening into plump and mellow pustules. Such putrid fruit might smell like death, but it heralded a far better chance for survival than any other form of the disease.

  On Christmas morning, the blisters on the queen’s face began to change, flattening and spreading into rosy spots. “Measles, after all,” said someone in quiet triumph. But not quiet enough: before the others could protest, the words were snatched up, stretched out, and tossed through the streets as news that the queen was clear of smallpox and out of danger. Cheers and hat tossings erupted through the city and the nearby countryside.

  The doctors, however, had not been quite so optimistic, nor had they been unanimous in this opinion of measles. Just as some predicted, the red spots proved not to be a new rash. By evening, it was clear that they were the old blisters in the process of sinking until they were once again level with the surface of the queen’s skin, buried but visible like vials of poison beneath glass. Watching helplessly, the doctors felt their hearts sink as well. The sores darkened to purple and black; they were outlined with rings of red like burning coals.

  That night, it seemed as if the queen’s invisible foe were clamping her chest in a vise; her breathing grew labored, and she began spitting up blood. The next morning, a gentle probe with a lancet revealed what the pessimists had feared most: her sunken sores had filled with blood. She was also bleeding into her urine and from her vagina.

  “Why are you crying?” she asked the crowd hovering around her bed. “I am not very bad.” They were brave words, but no one believed her. It was no longer possible to deny that she had come down with possibly the most monstrous of the several forms of this terrible disease that doctors then regularly distinguished: flat or crystalline or bloody pox, they called it. Late hemorrhagic smallpox.

  In the hours that followed, the queen’s face swelled as her mouth, nose, and throat filled with so many blisters that they ran together into one raw sore, making it agony to eat, drink, or speak. Blood seeped from around her eyes and through her gums. Her nose bled uncontrollably, and she began to vomit and shit blood. From her breath and body oozed a sickly-sweet stench of decay so thick that at times even her most devoted nurses fled the room, retching. The slightest brush against her peeled skin away in strips, leaving her shivering like a creature flayed alive.

  With a torturer’s cruel cunning, the disease did not touch the queen’s mind even as it ravaged her body. She was conscious until very near the end, inescapably aware of her transformation from beauty to beast. Late on the evening of the eighth day, she drifted into oblivion; she died at just past midnight on the twenty-eighth of December, only thirty-two years old. To most of those watching, it seemed a blessed release.

  They feared, however, that the king would go mad with grief.

  The queen missed deliverance by the slim margin of a single generation.

  As she lay dying in Kensington Palace, a rebellious five-year-old—also named Mary—was already kicking against the stiff skirts and even stiffer proprieties in which her family sought to encase her. Most of her days were spent miles away from the dangers and diseases of London, under the wide sky of the Wiltshire downs. For her health, she was trotted out from the rambling Jacobean manor house of West Dean and up into the downs to take the air in demure and ladylike fashion. Up there, though, she ignored the rules of the polite world that lurked in her grandmother’s house below. To the end of her days, she remembered racing as fast as her small legs would carry her, straining to reach the great golden bauble of the sun and pluck it from the sky before it set in the west.

  Mary Pierrepont had been christened in London, in St. Paul’s Church, Covent Garden, in May 1689, just one month after the coronation of William and Mary in Westminster. The infant was named in honor of her mother, who bore the same first and last names. Her first name was also a nod to the new queen, whose rise to power the baby’s family had backed.

  The honorific “Lady” was fastened to her first name before she reached the age of two, when her father, Evelyn Pierrepont, succeeded not one but two childless older brothers dying young, to become the fifth earl of Kingston; his vast estates amounted to his own petty kingdom.

  When Lady Mary was three and a half, her exhausted mother died from complication
s following the birth of her fourth child within three years and eight months. Along with her two younger sisters, Lady Evelyn and Lady Frances, and her new baby brother, William, Viscount Newark, Lady Mary was bundled into the country, into the cold care of their father’s mother.

  Only a few memories flared up from the dim years between the death of Lady Mary’s mother and that of her forbidding grandmother, when she was nine. Of her quest to catch the setting sun, she later wrote: “A fine thing truly, if it could be caught,” adding with an adult sigh, “but experience soon shows it to be impossible.” Her childhood self admitted no such defeat. When the sun lay out of reach, she chased the distant lumbering spire of Salisbury Cathedral, though the faster she moved, the faster it, too, ran away from her. Let other children play with shells and smooth stones, baby dolls and hobbyhorses: Lady Mary was born with a stubborn yearning for seemingly impossible glory.

  Several years later, to the hollow clop of horse hooves, the grind and spatter of coach wheels bouncing from pavement to muck, and the shouts of coachmen yelling for passersby to give way, a crowd of young men drifted like a bright perfumed flurry of confetti into a small tavern under the sign of the Cat and Fiddle. It stood in Sheer Lane off the Strand, just north and west of the Temple Bar, the stone gateway that once marked the western boundary of the single square mile that was the ancient City of London proper.

  The flashier men amid this crowd wore knee-length coats, breeches, and waistcoats (or vests) of jewel-colored velvet trimmed with gold buttons, silver lace, and fur. Long and luxuriously curled wigs framed their faces, while high, boxy heels displayed ankles and calves wrapped in silk hose. Battles had long since been won with gunpowder, but they still wore swords, and most of them still knew how to use them. They were followed about by as many bowing servants as they could afford; for a few, this amounted to a small private army.