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S was “the most terrible of all the ministers of death,” wrote English historian Thomas Macaulay. In the 17th century, the “small pox was always present,” unlike the plague, which visited on occasion. Before this time, the disease did not pose a serious threat to the English or other nations in Europe perhaps because, as scant available records suggest, less virulent forms of the disease were endemic. In his account of Queen Mary’s death (1694), Macaulay spoke of smallpox as indiscriminate and pernicious, attacking royalty and the poor alike, “turning the babe into a changeling at which the mother shuddered and making the eyes and cheeks of the betrothed maiden objects of horror to the lover.” Early in the century, the disease started appearing in English poetry, and in 1616, the year of Shakespeare’s death, Ben Johnson published “An Epigram to the Smallpox”: “Envious and foule Disease, could there not be / One beauty in an Age, and free from thee?” These writings refl ected growing awareness of smallpox as debilitating and deadly. By the end of the century, it had overtaken not only the plague but leprosy and the great pox, syphilis, and was spreading quickly in communities, disrupting the social fabric and causing epidemics similar to those that would sweep the globe in the 18th and 19th centuries. The general belief was that smallpox was carried from the sick on clothes and bedding, though the primary source of infection was actually particles of moisture in the patient’s breath. Infection traveled hundreds of yards by air, and the virus entered the body through the nose and mouth rather than cuts in the skin. Malodorous and disfi guring, smallpox held none of the mystique of tuberculosis, whose wasting febrile victims would later inspire romantic literature, music, and art. On the contrary, it struck fear in the hearts of poets, from Andrew Marvel to John Donne. Those who tried their hand at elegies struggled to align this “loathsome and unlovely” condition with internal beauty. A tribute by a young John Dryden to his friend Lord Hastings, who died the day before he was to marry, illustrates the pitfalls: “Blisters with pride swell’d; which th’row’s fl esh did sprout / Like Rose-buds, stuck i’th’ Lily-skin about. / Each little Pimple had a Tear in it, / to wail the fault its rising did commit: / Who, Rebel-like, with their own Lord at strife, / Thus made an Insurrection ’gainst his Life.” Dryden’s attempt in his fi rst published poem to liken Hastings’ pustules to rosebuds and later to gems and stars failed to transform smallpox to anything palatable. Dryden was not alone in confronting the reality of pathologic symptoms in a poem, but this disease, an everyday event, defi ed metaphorical interpretation and therefore transformative treatment. Moreover, it was not viewed as divine punishment for “Capital offense, / Some high, high Treason.” It remained instead, a “Fierce disease, which knows not how to spare / The young, the great, the knowing, or the Fair.” Records from Glasgow show that in the immediate prevaccination era (1783–1800), 50% of children died before age 10, and of those deaths, 40% were due to smallpox, the leading cause of blindness in Europe. Those who survived were often badly blemished, “Beauty’s Enemy” lingering “in many a pityed face / Those hatefull pits and furrowes of its trace.” The roots of smallpox in antiquity have been argued, as have efforts to control it. The practice of variolation― inoculation with a small amount of material from a pustule or scab of a smallpox patient—had long been known in Asia and was introduced to Europe and North America in the early 1700s. But it was not widely practiced because of the risk for disease or death to the inoculated person and the risk for creating new outbreaks.

The Fragrance of the Heifer’s Breath