Angel of Death: The Story of Smallpox by Gareth Williams (review)

Every phase of this narrative concerns the long eighteenth century. Variolation, or inoculation, first checked the career of smallpox as a killer (in Western medicine) in 1721; vaccination began to supersede inoculation in the 1790s; eradication of smallpox, which was celebrated in 1980, was first put forward as a goal by John Haygarth in 1793.

There is something Augustan about Mr. Williams’s handling of his subject. Deeply appreciative of the successive heroes of humanity’s ongoing war against the Angel of Death, he pulls no punches in anatomizing what he calls “human nature.” Pious Christian colonizers openly rejoiced at the extermination of native races by smallpox; most doctors in every age thought of their profit first and the patient second, and were quick to transform a simple, cheap procedure into a complex, exclusive, and expensive one; people with a stated commitment to education and the pursuit of truth pigheadedly resisted unwelcome facts; inefficiency and error were always endemic and when discovered were almost always covered up; actual life-or-death struggles of individuals or whole communities were sometimes “[n]eglected in the background” while pundits attacked each other’s views.

Even Mr. Williams’s heroes, the “visionary and bold,” were not exempt from “human nature.” Eighteenth-century inoculators refused to recognize that each of their inoculated subjects was, for a while, a spreader of the untamed disease (although their prototype, Lady Mary Wortley Montagu, had recognized the danger of infection from an inoculee); later Edward Jenner and others insisted that vaccination gave lifelong protection even as evidence accumulated that its effectiveness had a shelf life.

Until the early eighteenth century, Mr. Williams writes, doctors usually did more harm than good to their patients. Smallpox was rightly dreaded, since it killed on average one in five of its victims (sometimes as many as half), and did so with the maximum of physical and psychic pain (filling the mind with terrifying delusions as well as the skin with stinking, pus-filled sores). Most medicine involved toxic chemicals; most treatments used in smallpox, like bleeding, purging, vomits, and withholding water, were apt to finish off a precariously surviving patient. The rich were therefore less likely to recover from smallpox than the poor. I wish that Mr. Williams’s immense reading list included David Shuttleton’s Smallpox and the Literary Imagination (2007): he would have enjoyed as another aspect of “human nature,” the standard discourse that evolved among poets lamenting the smallpox deaths of Stuart royalty and other eminences, which transformed pustules into gems and smallpox itself into violent insurgency. This early technique for evading the disease’s worst horrors was followed by others very different.

Mr. Williams excels at tracking a vivid story line through thickets of distracting detail, as he does with the early life of Lady Mary. He also captures the fuzziness of the narrative, whose series of advances is complicated not only by reverses but also by parallel subplots, by hopeful beginnings which peter out in dead ends, by pauses of inattention and inertia. For instance, at the time that Lady Mary introduced inoculation to England, ordinary working people of Marloes in South Wales had for generations been “buying the smallpox” (in 1700 they paid threepence for the fluid from twelve pustules) in order to scratch their skin, rub in the fluid, take a mild bout of the disease, and acquire lifelong immunity. This practice was not brought to the attention of the intelligentsia (that is, the Royal Society) until inoculation had already arrived, and perhaps more astonishingly still it seems never to have spread beyond a restricted area, as one might expect it to do through marriage and the founding of new families.

Welsh villagers apparently ignored customs of the next village, even those with the potential to affect the health and survival of their children. More surprisingly, the Royal Society failed to investigate either “buying the smallpox” or the practice of inoculation itself. Arab and African inoculation, and...