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The Speckled Monster

The Speckled Monster

Jennifer Lee Carrell - Author

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ISBN 9780452285071 | 496 pages | 27 Jan 2004 | Plume | 5.51 x 8.38in | 18 - AND UP
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A timely book about history's first desperate efforts to conquer smallpox

The Speckled Monster tells the dramatic story of two parents who dared to fight back against smallpox. After barely surviving the agony of smallpox themselves, they flouted eighteenth-century medicine by borrowing folk knowledge from African slaves and Eastern women in frantic bids to protect their children. From their heroic struggles stems the modern science of immunology as well as the vaccinations that remain our only hope should the disease ever be unleashed again.

Jennifer Lee Carrell transports readers back to the early eighteenth century to tell the tales of Lady Mary Wortley Montagu and Dr. Zabdiel Boylston, two iconoclastic figures who helped save London and Boston from the deadliest disease mankind has known.

In Georgian London, Lady Mary Wortley Montagu sweeps out of a palatial bedroom in a swirl of satin and silk, her three-year-old daughter in tow. The servants are impassive as she floats by, but in her wake their faces pinch in disgust and their eyes meet in knowing glances. "Unnatural," hisses the nurse to a maid. Ignoring them, she descends the grand staircase like the duke's daughter she is, but at the tall doors to the street, she pauses. She has grown accustomed to the delicate razors wielded in the plumed, powdered, and diamond-frosted high society of aristocrats and artists: countesses and poets once proud to claim her acquaintance now make ostentatiously absurd claims to parade out of any room she enters. But even that is less harrowing than what happens in public. She sets her shoulders and nods to the footmen, who swing open the doors. As she steps into the street, heads turn, and people begin pointing and jeering.

Just as the door closes on the safe haven of her coach, a servant in silver livery hands her a tray of carefully stacked notes: even as some mothers teach their children to taunt her, others send footmen day and night to beg for her presence. When they find her away from home, they fan out through the winding lanes of London to track down her carriage, wherever she may be.

In colonial Boston, Zabdiel Boylston rides down a muddy street; his black slave Jack follows on a mule, packing a satchel full of the tools of Boylston's trade: he's a general surgeon and an apothecary, or pharmacist. He's never been to college, but the townspeople call him "doctor" anyway, in honor of his skill. After years of practice, and before that, years of apprenticeship with his father, he's the most trusted medical man in town. A recent arrival from Scotland, William Douglass, is beginning to protest, however: Dr. Douglass may be eleven years younger than Boylston, but after studying at no fewer than four European universities, he has earned a proper medical degree. His peacock pride is infuriated by the mere presence of this untrained competitor for his fees, and even more so by the trust the provincial fools of Boston put in him.

So far, Boylston has paid no mind to Douglass's sneers: he cares little for tradition or titles. What he cares about are honest hard work and results.

That was before the recent outbreak of smallpox, however. Now, like Lady Mary, Boylston is hooted at and splattered intentionally with filth whenever he steps into the street. For fear of lynch mobs, his wife and friends beg him not to go out after dusk, but the stealthy knocks keep coming, followed by urgently whispered requests: Will you come now, before it's too late?

Always, he gives Jack the nod, puts on his coat, and goes out.

This is a tale of two smallpox-haunted cities and the two unlikely heroes, both outsiders to the elite ranks of the medical profession, who began the fight against that terrible disease in the Western world in the 1720s. Lady Mary Wortley Montagu and Zabdiel Boylston were not scientists; their struggles against smallpox were not systematic or even logical, according to the medical knowledge of the day. Their crusades against the "speckled monster" of smallpox were deeply personal.

Beyond speaking English, Lady Mary and Boylston had almost noth-ing in common. Lady Mary was the daughter of one of the British Empire's wealthiest and most powerful dukes, and the wife of one of its wealthiest private subjects. Shuttling between palatial London town-homes and grandiose country estates, she had been surrounded by opulence almost since birth. She was a study in contrasts: celebrated since childhood as a small, black-haired beauty, she cared more for rapier duels in the world of the mind than fame in the world of fashion. She spent hours reading romances and travel adventures in her father's plush library, and she loved biting word-play and wild flights of the imagination. Very early, she began scribbling her own stories. She was a Georgian Scheherazade who had the habit of telling her life's story as a fairy tale, but her heroines, like herself, were not docile princesses meekly awaiting rescue-though in the age's spirit of mockery, she christened one of them Princess Docile. Lady Mary's heroines were rebels who got themselves into trouble.

She was also one of the greatest letter writers to grace the English language. Even in hurried or teasing notes, she tells stories, deftly sketching scenes and dialogue and catching quirks of character. Thankfully, many of her correspondents recognized masterpieces when they saw them and saved her letters. She herself edited the letters she wrote home during her travels to Turkey, arranging for their publication after her death.

Her diary has a more frustrating history. Begun when she was young, it grew to many volumes: if it had survived, it would offer a woman's early eighteenth-century rival to the chatter of Samuel Pepys, whose diary remains one of the most entertaining and encyclopedic descriptions of late seventeenth-century life in London. Unfortunately, Lady Mary's diary, like a great deal of women's writing from that period, was burned by her loving family, for the sake of preserving reputations, hers included. All that remains of her journals are the memories that her granddaughter, Lady Louisa Stuart, retained of having read a few of the volumes many years before, set down in writing in 1837 as "Biographical Anecdotes of Lady M. W. Montagu."

In high contrast, Zabdiel Boylston wrote only when necessary. Boylston was a third-generation colonist who had grown up hunting, fishing, farming, and doctoring on the fringes of a vast wilderness half the world away, in the western hamlet of Muddy River, Massachusetts. Now known as Brookline, his birthplace was tiny and provincial even by the standards of the booming frontier port where he would eventually make his home: Boston, then sandwiched between the sea and the seemingly endless American forest.

To Boylston, words were tools to be used sparingly. He had learned his profession not from books but from long practical apprenticeship with his physician father. In 1726, certainly at the behest of the Royal Society and possibly at the request of the Princess of Wales, he told his side of the story in An Historical Account of the Small-Pox Inoculated in New England, including his case notes for inoculations performed in Boston in 1721 and 1722. It is a deliberately dry format, careful and concise; even so, a wry wit shines through. Though capable of humor, he was for the most part laconic, stubbornly upright and independent-an early incarnation of the American frontier hero.

Boylston and Lady Mary shared one crucial experience, as even a fleeting glance at their scarred faces could have told: they had both won vicious battles against smallpox. They knew firsthand the horror of a disease that could turn people into grossly swollen, groaning monsters barely recognizable as human, bubbling with pus and reeking with the sickly-sweet smell of rotting flesh. They knew the agony of skin that felt sheeted in flame, and a mouth and throat so full of sores that some victims died of thirst rather than endure the pain of swallowing. That lone shared struggle turned out to be enough to make them change the world-at the same time and in the same way, though unknown to each other.

In telling this tale, I have tried to remain faithful to its two heroes, not only as historical figures but as storytellers. In honor of Lady Mary's love of a well-told story, I have done my best to lift dry, briefly outlined scenes back into drama, relying on evidence from elsewhere to add details of sight, smell, and sound; food, clothing, and furniture; medical beliefs and scientific facts; music and poetry; even weather. Where history reports dialogue indirectly or leaves it merely suggested, I have returned it to full conversational life-while keeping as close to what was actually said as possible, often by borrowing known words from similar situations. I have drawn connections left implied by timing or juxtaposition. At times, the narrator speaks with the words and phrases of Lady Mary, Boylston, and their cohorts-not always set apart in quotation marks-to allow the reader to look at the world through their eyes, as well as to look at them, like marvelous butterflies pinned beneath museum glass.

The notes, in the form of short essays at the back of the book, are in honor of Boylston-and all those who like their certainties sharply demarcated from surmise, or who just enjoy the tension and spring between history and story.

For all our current fears, we are inestimably lucky to live in a world in which the threat of smallpox has shifted from ordinary to extraordinary. Paradoxically, in the absence of smallpox as an everyday enemy, it is hard to realize just how lucky we are. Sheer numbers may help. By the time the disease was vanquished in 1977, it had become far and away the most voracious killer ever to stalk the human species. With a victim count in the hundreds of millions, smallpox has killed more people than the Black Death and all the bloody wars of the twentieth century put together.

The eradication of smallpox from nature remains one of the greatest victories of modern medicine. Across the 1960s and '70s, doctors and health workers by the hundreds of thousands hunted the disease down in its last hiding places in Asia and Africa, driving it relentlessly toward extinction by a "scourged earth" policy. By lure, education, bribery, and finally by force, they vaccinated everyone within reach of the variola virus that causes smallpox.

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.

Part 1: Chapter 6
Rosebuds in Lily Skin

Covent Garden, London
April 1721

Lady Mary shivered and drew closer to the fire glowering in the library grate.

She was reading John Dryden, as she often did when troubled, or tired, or sad. Since early childhood, his cadences had been as familiar and comforting to her as her own heartbeat. This afternoon, though, even Dryden betrayed her: his rhythms felt disappointingly brittle and his sensibility primly arch. How she longed, some days, for the perfumed sensuality of Turkish poetry, which she had breathed rather than read, it sometimes seemed, in her kiosk by the sea in Pera.

She rubbed her eyes-sore today-and glanced back down at her book, open to a rather bizarre elegy on Lord Hastings, dead many years ago now of smallpox-or the "filthiness of Pandora's box," as Mr. Dryden had put it. Which made the poem really rather relevant, come to think of it, though in fact it had been his first published work.

It was a marvel that it had also not been his last. What was one to make of such passages as this? She read the line again:

Blisters with pride swelled, which through's flesh did sprout
Like rosebuds stuck i' th' lily skin about.

Really, she thought with a rueful laugh, it was all too romantically gruesome. Besides roses strewn upon lilies, Mr. Dryden had turned his patron's pocks into tears, glowing gems, even a constellation of rebellious stars. How had he ever restrained himself from adding in a fiery fall of angels?

A few months ago, she would have clapped her hands in glee at such absurdity and concocted some witty remark to send winging through the more intellectual drawing rooms of Covent Garden, Piccadilly, and St. James's. But then, a few months ago, violets and roses had blossomed in January, and she had thought it a fine omen of unlooked-for loveliness. Now, she deemed it more likely to have been a warning, the last valiant exhalation of beauty they might see for years to come. Perhaps the early bloom had even been a demonic joke: a gorgeous mask that Beelzebub himself had donned just long enough to slip unsuspected into the never-ending party of London's western suburbs.

Since then, the demon had tossed off his disguise and pounced. Struggling in his talons, the world had lurched upside down.

But she was being dramatic, she told herself. Mr. Wortley would most certainly say that she was being dramatic.

Surely, though, it would be fair to say that after that early and all-too-brief warm spell, the weather had dipped into unseasonably cold weeping. Worse, the smallpox had begun slashing its way through her friends and family.

In point of fact, her husband had grunted just that morning, the distemper had been trampling through the city almost without pause since they had returned from Constantinople. She had merely ignored it, because it had lingered in the slums and tenements of the East End, St. Giles's, Westminster, and Southwark. Dank and dangerous places, she retorted, where he would have chided her for going. As for smallpox in St. Giles's, it might as well have been fever on the pockmarked moon.

St. Giles's, Wortley had acidly observed, was no more than a few streets away. A few streets, and many worlds, she had said, sailing out of the room.

Soon after their return, Mr. Wortley had gratified her by purchasing a mansion in Covent Garden-Nos. 9-10, the Piazza-quite a la mode, for a woman of artistic bent and intellectual prowess, though the neighborhood was daringly racy by the standards of her more blue-blooded friends. Still, it was genteel, even if its notion of gentility admitted poets, painters, philosophers, and even a few politicians on the basis of merit and manners alone, waiving the need for much of a pedigree. Lady Mary had happily immersed herself in creating a home that was a work of art, and in rekindling old coteries and salons, as well as sparking some anew.

Then Princess Anne, the eldest of the king's granddaughters, had gone down with smallpox last April-could it already be a year ago? Even at that point, Lady Mary had not managed to conjure up much real anxiety, though of course, she had, along with the rest of the kingdom, fretted over the little girl's fate. Anne's illness did not, however, seem a real and personal threat. After all, the palace was a veritable bedlam, people of all sorts endlessly creeping, pushing, battling their way in to see the king, or at any rate, to see whoever happened to be perched on the highest rung they could reach in the cascading hierarchy of royal lackeys.

These days, she had little to do with the palace, though she still often attended the regular weekly suppers put together for the king by the countess of Darlington-the exalted new rank of her fat, witty, half-royal, and wholly loyal friend, Madame de Kielmansegg.

By contrast to the young princess, Lady Mary told herself with satisfaction, her own little Mary was safely cocooned within private walls, surrounded by family and carefully screened servants.

Besides, at the time that the princess fell ill, there had been candidates that seemed much stronger than smallpox, if she really felt the need for a good worry: two and a half years before, the idiotic Prince of Wales, for instance, had turned both the court and the ministry upside down by openly challenging the power of his father in Parliament. In return, of course, the king had determined to crush his son, both politically and socially, once and for all. For starters, he had had him ejected from the palace, and the doors barred behind him.

Far from humbly returning to beg pardon, the prince had flounced off to Leicester Square to scheme against the king from an impertinently short distance. To the king's further dismay, Caroline, Princess of Wales-one of the few persons on earth who could cajole his son into sense-had voluntarily joined her husband in exile. Reluctantly, the king had let her go. He did not, however, allow her to take her children: he kept the three little princesses and their infant brother with him, at St. James's. Hostages for their parents' good behavior, the world had muttered, and for the most part the world had been right. But in some part, Lady Mary surmised, the king's decision had also been purely personal and selfish. Quite simply, he loved his grandchildren. He did not wish to give them up.

For courtiers and ministers alike, this familial war had been a two-year stomach-churning nightmare. In the end, everyone but a few of the prince's most obsequious creatures had adhered to the king-How could the prince have failed to foresee that? she clucked to herself for about the millionth time. On the other hand, even the staunchest of the king's men-Lady Mary's own father among them-saw that since George I was not immortal, they could not afford to alienate the prince in any lasting way.

It had been in the midst of this rift, not long after a heart deformity had sent her new little brother, blue lipped, into death, that ten-year-old Anne had fallen ill. Even from this distance, Lady Mary shook her head. Were the doctors not always cautioning their patients to keep their minds and hearts full of good cheer? How could even the most obtuse of ten-year-olds maintains good cheer in such a storm of vicious anger as had ripped Anne's family apart? That poor little princess had surely not been able to count good cheer among her allies as she fought off the smallpox.

She had very nearly lost that fight, rallying back even as the doctors had been preparing her squabbling royal elders for the worst. Remembering, Lady Mary shook her head. The princess had survived, but she was sadly scarred. At least Lady Mary had had a few years to revel in the delights of being young and beautiful in London, before her beauty had been scraped from her. Even so young, this princess was already famously accomplished; she would always be wealthy, always possess the power of her rank and her well-trained mind. Those, as Lady Mary well knew, were delights of their own, in many ways richer, deeper, more lasting. But they were not the same as the bright, fickle flame of beauty. Lady Mary allowed herself a rare sigh of regret. No, they were not at all the same.

As soon as the girl had fallen ill, the king had made quiet arrangements for the Princess of Wales to attend on her sick daughter as much as she liked. This proved to be most of the day and night, except for the hours when the king himself wished to sit and read to his little Annie. He had stood firm, though, on the point of his son's exile from the palace.

Gradually, Caroline had whittled away at his obstinate anger; quite possibly, death's obstinate hover over his grandchildren had also softened him. In any case, it had been in the sitting room just outside Anne's sickroom that delicate negotiations toward a familial peace had been joined. The prince might be too jealous of rank and power to realize that what he really needed was patience, but the princess was a consummate politician. She was quite deft when it came to handling both her husband and her father-in-law, especially when she was allowed to handle them separately, in private.

So she had engineered a tete-a-tete, just the king and herself, in a small chamber next to Anne's, ensuring that no voices would be raised and no tempers lost, if only for the sake of the child only one door away. A few days later, as Anne crept out of danger, the prince himself arrived to make formal submission to the king. All London-indeed, the entire nation-breathed a deep collective sigh of relief.

For courtiers, though, the respite had proved brief. While the king and the prince patched up their differences, the dreaded disease jumped the palace walls. For six months, it tiptoed furtively about the neighborhoods west of the City. Since the New Year, though, it had been cutting swathes of hot agony through the fashionable streets of St. James's and Piccadilly, sending Lady Mary's friends and family blistering and bubbling into heaven or hell.

Lady Mary had been able to ignore it until James Craggs died on the sixteenth of February. Four days later, her sixteen-year-old cousin Lady Hester Feilding succumbed, having shed her precocious beauty almost as fast as she acquired it. Up in Russell Square, the duke of Rutland and two of his daughters had all died within two weeks of each other, leaving Bloomsbury in mourning and mostly empty. All over London, but especially in the west, the whirl of parties and salons had ceased: not knowing who might be exhaling the infection, ladies had grown afraid to face each other across tea tables, and men shunned even old friends at cards. The crowds at the theater had thinned and drooped.

With all amusements off, there was little left to distract her from the smallpox but the crash of South Sea stock. With the help of Mr. Craggs, she had invested heavily. Who could have guessed, she cried at her own walls that such a firm, one of the country's largest trading companies-a financial behemoth big enough to treat with the government in the servicing of the nation's debt-could be a fraud? A collectively dreamed glimmer of soap, bubbling on a breeze? Who was to know that when its fragile film of popularity burst, it would dissolve vast fortunes into thin air?

Her money-a sum sickeningly large, though not bankrupting-had shriveled in a matter of days, but it was not as if she was the only victim. Parliament was sniffing about for a scapegoat; everyone who had made money was suspect. The king himself was looked at askance. Really, it had been just as well that poor beautiful Mr. Craggs had died when he did, for he had been deeply implicated in the scandal. So deeply that his father, unstricken by smallpox, had committed suicide a few days later. Everyone was dying.

A knock at the library door startled her. "What?" demanded Lady Mary, rising.

"It's nurse," stammered the maid.

Lady Mary crossed the room and flung open the door so quickly that she nearly tossed the maid against the wall.

The nurse's room was off the night nursery, two stories up. Just inside, she lay shivering on her bed, flecks falling in an angry red snow down her body.

"Where is my daughter?" demanded Lady Mary, her mind spinning and her heart trying to pound its way out of her stiffly boned bodice.

"I'm sorry, my lady," whispered Nurse. "I've tried to be so careful."

"Where is Mary?"

"Downstairs in your own parlor, my lady. She's fine, not ill at all. I sent her down in Charlotte's care, soon as I realized what was happening. Charlotte's a good girl."

Charlotte, thought Lady Mary, is a feather-brained fifteen-year-old. But at least she is already pockmarked.

The nurse began to cry.

"Hush," said Lady Mary, crossing the room and giving the woman her hand. The woman did love young Mary, and had been with her since her birth. But it was hard not to notice that none of this would be happening if she hadn't so adamantly refused to be inoculated while in Constantinople. Inoculated while in Constantinople. The full force of those words jolted her through her brain.

The nurse had been saying something in between sobs. Lady Mary couldn't make it out. "It will be all right," she said absently, patting the woman's hand.

Within half an hour, the nurse was bundled up and packed off to a certain house in Swallow Street, down in Piccadilly, where the servants of the aristocracy were sent to suffer through smallpox with kind care, at a safe distance. Footmen had been sent scurrying through the streets with notes inquiring after the availability of suitable short-term nursemaids. And her own carriage had clattered away in search of Mr. Charles Maitland, with orders not to return without him.

Two hours later, Mr. Maitland was shown into a sitting room that resembled a pleasure palace straight out of the Arabian Nights.

Sitting cross-legged on an ottoman behind a jewel-encrusted coffee set, Lady Mary was resplendent in her flowing Turkish costume, the thin rose damask embroidered with silver flowers and the jeweled cloth-of-gold rustling and clinking softly as she moved.

He bowed low, in the ostentatious manner of the Turkish court. "You must have a djinn at your mercy, my lady," he said as he straightened. "How else you could have transported such an exquisite corner of Constantinople to Covent Garden, I cannot begin to think."

"I admire the art and the poetry of the Ottomans," said Lady Mary with a smile as she poured out the thick coffee. "And I like to think I can offer some poor shadow of their grace in entertaining," she added, handing him the tiny cup.

He raised the sweet steaming brew to his lips.

"But I fear that in the matter of Turkish medicine I must beg your help," she added.

He froze, and his eyes met her gaze over the rim of the cup.

"I want you to inoculate little Mary," she said.

He set the cup down with a click. "I am honored, Lady Mary, by your trust," he said, stalling.

"Today," she said, leaning forward.

"In such matters, my lady, it does not pay to be hasty."

"In the matter of the smallpox," she countered, "it does not pay to hesitate. In any case, you have had three years to mull over the results of inoculating my son."

"The season is too cold," he objected. "In Constantinople, they operate in a warm season."

"Here, it is a smallpox season," said Lady Mary, never taking her eyes from him. "Mary's nurse erupted this morning."

He had of course, surmised what she wanted. Had surmised several months ago that she might want it. If anything, he was surprised the request had taken this long. He knew her well enough to know that when she set her mind to something, she did not take no for an answer. He knew he was not going to win this contest. Nor did he want to, really. He had seen the experiment work with his own eyes; even a remote possibility that it might work here in Britain made it valuable. But he wished to proceed with caution.

He also wished to make certain demands, though perhaps it would be better to say that he wished to put certain protections into place. For this was not Constantinople, though she seemed to want him to think it was. They were in the heart of London. And she was not asking him just to be a witness, as he had been in Turkey, where he'd merely stepped in to clean up a barbarous operation he had not begun. She was asking him to be the sole operator.

He was less sanguine about the outcome than she was. He had no wish to be charged with the murder of the granddaughter of a duke, and the daughter of an ambassador. It was paramount that he not work in secret. But how was he going to convince Lady Mary?

Let her win a lesser battle, said the voice of instinct. He cleared his throat. "It is not your son I am concerned about, it is your daughter. She must be prepared."

"She's strong as a horse," said Lady Mary, waving that notion off. "Her diet is clean and her exercise regular. I will not have you draining her blood and calling it useful."

He bowed. "Very well," he conceded.

Her eyes narrowed. "You want something else. What is it?"

Really, she was unnervingly perceptive. As smoothly as possible, he came out with it. "For you, my lady, this operation offers great personal benefit, in exchange for grave personal risk, as you well know. I hope, however, that you will consider sharing that benefit. Will you allow me to choose two physicians to witness the operation, in order to contribute to its credit and reputation, as well as to consult on the health and safety of your daughter?"

She sprang to her feet, her eyes flashing. "Certainly not," she exclaimed. "Under no circumstances will my daughter be exhibited to curious crowds like a carnival monkey."

He knew she had no high opinion of physicians, but still, the force of her refusal took him aback. Another, less patient man might have lost his grip on his own patience, and tried to argue with her, but Mr. Maitland knew her better than that. He called her bluff. "Then, my lady," he said, rising after her, "I must regretfully decline your kind offer to make use of my services."

Before she could recover, he had bowed and departed.

Three days later, she summoned him back again. The nurse's case was not going at all well, and fear was thickening her blood by the hour.

This time, he was shown into a proper English room; in the guise of a proper English lady, Lady Mary was standing by a window, with her back to him. "Two," she said imperiously, as he walked into the room.

He bowed. "Three," he countered. There was no need for either of them to specify that it was the number of physician witnesses they were discussing.

"Last time it was two," she said, glancing over her shoulder.

"Now it is three," he said.

She turned away again. "One at a time."

"I agree."

"And I will be present throughout." She whirled around. "I will not have physicians corrupting the operation out of sheer malicious rancor, for fear its success will dry up their revenues, along with the town's pocks."

He let her outburst skid by him. "You will find the city and the nation grateful, my lady. Now if you will excuse me, I will make the necessary preparations."

"No preparations," she snapped. "No prior bloodletting, no purges, no vomits. As I said, she's strong as a young horse."

"Yes, my lady. But that is not the sort of preparation I meant." It had been, of course, but it would not do to let her yet realize it. He liked her on the defensive. "I must acquire some promising matter."

"How hard can it be to scrape pus from a pock in London?" she cried. "Why haven't you already done so?"

"With all due respect, my lady, I was not sure we would come to an agreement. Now that we have, I am sure you do not want me to be quite so cavalier in this matter as you suggest. I must find a suitably clean subject, with no other history of disease, at just the right stage of a light, distinct smallpox. You do not want to shield Miss Wortley from smallpox, only to give her the great pox, or a consumption."

Lady Mary sighed, tapping one foot impatiently. He saw her thinking furiously. "Be quick, then," was all she said in the end.

As it turned out, he had one week's preparation for himself, and his three witnesses, but only after the fact: they were engaged to see Mary as soon as the rash came out, and not a moment before. And he won no preparation for the girl at all, though he kept lobbying for it right up until the last moment.

Lady Mary held her daughter on her lap right through the procedure, kissing the top of her fair downy hair, and singing her favorite songs. The girl wriggled a bit, but not badly: Mr. Maitland was deft and swift, and she had known his voice all her life.

The little girl liked him. To her, he was tall as the clouds and almost as gentle, with a funny way of talking. His r's were furry. Or bumpy. She couldn't decide which. Mamma said he sounded that way because he was from a place called Scotland. Considering this mystery, she sat grave and wide-eyed, only turning away and screwed her eyes shut when he drew out his lancet. She knew he was trying to be kind, so she tried to be brave. But as she felt a prick in each arm, one tear squeezed from each eye and trickled down her cheeks.

The incisions opened and wept early, growing day by day. Two, three, four, five. On the sixth day, Lady Mary was so restless, she snapped at Cook, reduced the new nurse to tears, and sent old Jenkins, the coachman, fleeing for his life, all within five minutes. Directly, she locked herself in her bedchamber lest she transform into a full-blown dragoness. The sixth day spilled into the seventh, and still no fever appeared. Flushes crept across Mary's porcelain skin, sometimes alarmingly bright, but they were accompanied by no hint of heat. The count of days increased to eight and then nine. On the morning of the tenth day, Lady Mary began to fear that she would begin throwing things.

That afternoon, bells pealed all over the city: the Princess of Wales had given birth to a son. Wine flowed in streets crowded with dancing and cheering.

Late that night, the new nurse appeared at Lady Mary's door, frightened out of her wits. The child had grown warm, though still not hot. She was restless and fretful, though, and crying out for her old nurse, or her mamma. Lady Mary, for once, was glad to indulge the child.

The fever was not so high as to be terrifying. Nonetheless, it was a smallpox fever, and rising. She sent for old Mr. Brown, the ancient apothecary who had apparently been serving the neighborhood since the last visit of Caesar.

He was none too pleased to be hauled out of bed at midnight, though his way across the square had been well lit by celebratory bonfires and cheered on by happily drunk crowds. He was horrified to discover that the child had been given the smallpox.

He turned reproachful eyes upon Lady Mary. "There is nothing to be done now, my lady, but let Madam Nature take her course. If she behaves, the fever will go off of its own accord by morning."

Somehow, Lady Mary ground out thanks as the man left, and settled down in the nursery rocking chair to wait. To her mind, Madam Nature did not deserve much in the way of trust.

The Speckled Monster Acknowledgments
Introduction
Part One. London
1. Two Marys
2. Three Rebellions
3. A Destroying Angel
4. Bidding the World Adieu
5. My Dear Little Son
6. Rosebuds in Lily Skin

Part Two. Boston
1. Zabdiel and Jerusha
2. Curiosities of the Smallpox
3. The Beauty of the Sea
4. Caging the Monster
5. Demonic Wings
6. Fathers and Sons

Part Three. Hell Upon Earth
1. Salutation Alley
2. Prying Multitudes
3. An Infusion of Malignant Filth
4. The Castle of Misery
5. Signs and Wonders
6. Newgate
7. An Hour of Mourning
8. The King's Pardon
9. Raw Head and Bloody Bones
10. Just Retribution
11. In Royal Fashion

Aftermath
1. Meetings and Partings
2. The Practice
3. The People

Notes
Abbreviations
Sources
Bibliography

"Highly engrossing...Carrell tells the gripping story with ardor and skill." —Smithsonian

"Written in a compelling, almost novelistic voice, Carrelldetails two eighteenth-century figures who struggled valiantly against smallpox. The disease becomes a character in the book, claiming the poor, the rich, and the royal without distinction." —USA Today


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