The Scourge of Smallpox in Early Modern England by Deborah Swift

Unbearable Pain

We are fortunate to live in an age where smallpox has practically been eradicated. In the eras when my novels are set, this disease struck indisciminately, both rich and poor alike. Researching the plague, I have read a lot about smallpox epidemics in my research. Although we often hear of the plague in the 17th century, smallpox killed more people and was just as deadly.

If you caught smallpox you would begin by suffering a high fever, along with vomiting, and severe stomach pains. This would often be followed by delirium and a red rash which started on the arms and legs and then spread to the face. The pox proper - pustules filled with liquid, usually appeared after about six days, beginning on the forehead and wrists and spreading into the mouth and throat.

A case from 1886

Unlike chickenpox, smallpox affected the palms of the hands and soles of the feet, which made touching anything unbearably painful. If there was no-one to look after you, you were likely to die of starvation or dehydration. If that weren't bad enough, smallpox brought other complications in its wake - bronchial infections, ear infections, gangrene, and even paralysis. No wonder the disease was so feared.

A Colonal Treatise on smallpox

Smallpox Scars
Probably the most famous smallpox sufferer was Elizabeth I, who covered the resulting pitting with her now trademark white lead. As a queen, her power was such that it did not affect her fortune, but in an age where a woman's trade was her looks, catching smallpox could change lives forever. Those who survived an attack were often severely pockmarked, and to counter this effect, women wore veils, masks or patches (beauty spots) to hide the worst of them.

Hannah Woolley in her book 'The Accomplish't Lady's Delight' advises a 'lemon and sea salt wash', whereas the physician William Salmon (1695) recommends bacon dripping scented with rosewater to soothe pitted skin.

Scars were a mild discomfort, for death from the disease was common and in the 17th Century John Evelyn records in his diary how his daughter, Mary, suffered and eventually died at the age of 19, causing him 'unspeakable sorrow and Affliction.' 

Woman at Toilet - Gilles Petit, showing patches

The effect of the virus grew during the 16th century but reached epidemic proportions by the early 17th century. At most risk were those in the capital, where crowded conditions made the spread of the disease easy, and the epidemic of 1694-1695 killed Queen Mary.

Causes and Cures
John Aubrey writes that;

'the small-pox is usually in all great towns...at one of them every seventh year and at the other every ninth year...which the physicians cannot master.'

Like many, he believed the disease to be cyclical, and to be caused by infected air. Thomas Sydenham (1624-1689), a physician, noticed that the rich seemed to die more often from smallpox than the poor. His conclusion was that the treatments killed as many as they cured. Though I have to say, his own methods seemed extreme; here is  a patient's description:

“Whilst I lived in Dr Sydenham’s house, I had myself the Small Pox, and fell ill on the Twelfth Day. In the beginning I lost twenty two Ounces of Blood [from bloodletting]. He gave me a Vomit, but I find by Experience Purging much better. I went abroad, by his Direction, till I was blind, and then took to my Bed. I had no Fire allowed in my Room, my Windows were constantly open, my Bed-Clothes were ordered to be laid no higher than my Waste. He made me take twelve Bottles of Small Beer, acidulated with Spirit of Vitriol, every twenty Four hours. I had of this Anomalous Kind [of smallpox] to a very great Degree, yet never lost my Senses one Moment.” 

Thomas Dover, The Ancient Physician’s Legacy to His Country

A Old Crypt Causes Fear of Infection

The excavation of the crypt of Spitalfields church in London in 1985 raised the genuine possibility of re-introduction. The bodies - three thousand of them, preserved in lead-lined coffins, were from the 18th and early 19th centuries, and about 10% were known to have died of smallpox. The Victoria & Albert Museum staff used medical precautions when dealing with them, as it is not known how long the organism can survive.

Thread Inoculation

A Norwegian vicar in about 1700 reported that people “bought pox”  to ensure a mild attack. They rubbed a coin on open smallpox sores, then made a thin cut in the skin of healthy children and tied  the coin tightly to the wound; this acted as primitive immunisation.

Lady Mary Wortley Montagu (1689-1762) hit upon the same idea and is credited with introducing variolation or 'ingrafting' to Britain in 1721. Severely pockmarked herself, after surviving the illness from which her brother died, she learnt about variolation in Constantinople, where her husband was the British Ambassador. 

Ingrafting consists of taking a small amount of infectious matter from a sufferer and using a thread, introducing it to a small cut. After that, the wound would be bandaged and a mild case of small pox would ensue. This prevented a more severe infection. Lady Montagu, who lost her eyelashes completely to the disease, had her children inoculated and persuaded the Princess Caroline to do the same, thus earning a Royal seal of approval.

In 1796 the idea was developed further by Edward Jenner, widely credited with being the instigator of immunology. He noticed that milkmaids, who often contracted cowpox, were immune to smallpox.

Jenner infects his gardeners son

So he infected James Phipps, the son of his gardener, with cowpox from Sarah Nelmes, a milkmaid who had caught the infection from a cow called Blossom. The boy was then exposed to smallpox and did not contract the disease. Somewhat risky - I don't think I would have been prepared to risk it for my child! But thank goodness he did, for the deadly and disfiguring disease is now a terror of the past.

Sources: 

Maladies and Medicine -Jennifer Evans and Sara Read

US National Library of Medicine

Epidemics and History: Disease, Power and Imperialism - Sheldon J. Watts

Images from wikipedia

Coming Soon from Deborah: A Plague on Mr Pepys

Find me on Twitter @swiftstory

THE KING'S EVIL, by Y S Lee

Hello, HG readers. I’ve been reading Liza Picard’s juicy social history of Restoration London. It is GRIPPING! Until now, I had only a hazy overview of the period, acquired during an undergraduate course on Restoration and Eighteenth Century literature. I loved the course but apart from a few gossipy snippets about Aphra Behn and the Earl of Rochester, I’d shed most of the details.

So when I ran across the phrase “the King’s Evil” in Picard’s book, I tripped over it. The what? “The King’s Evil” is another name for scrofula, a swelling of the lymph nodes in the neck. It’s often associated with tuberculosis. Apparently, the swelling itself is not painful but it is disfiguring and is further associated with fever, chills, and weight loss. 

image via wikipedia

That’s interesting enough, but what has it to do with the king? Apparently, in both France and England, monarchs held ceremonies in which they laid healing hands on those suffering from scrofula. This was called “the royal touch”. It was both a demonstration of their paternal care for the people and an affirmation of their divine right to rule. The ceremonies included prayer and sometimes the gift of a gold coin or ribbon to the sufferer, a talisman of the king’s power.

Here’s an image of Charles II, England’s most enthusiastic practitioner of the royal touch. (This makes perfect sense: Charles II had a lot to prove, as a freshly restored king.) According to Picard, he held weekly ceremonies, kept up the practice when he travelled outside London, and touched about 4500 petitioners in each year of his reign!

Charles II, administering the royal touch

The last English monarch to practise the royal touch was Queen Anne. Her most famous “patient” was the young Samuel Johnson, who contracted scrofula as an infant. His family took him to St James’s Palace in March 1712, when he was two years old. Queen Anne took her healing duty seriously, usually fasting the day before the ceremony. 

Queen Anne, "healing" a subject. Edited: as Leslie Wilson observes in the comments, this can't possibly be Anne unless she's wearing fancy dress. It's Mary I. Apologies!

Predictably (to us), Queen Anne’s touched failed to cure Johnson. He later endured surgery that left him with permanent scars on his face and body.

To our minds, it might seem strange that so many people clamoured for the royal touch. There is a medical reason: scrofula is rarely fatal and often goes into remission on its own. If one’s remission coincides with the king’s touch, one has anecdotal proof that the royal hands can heal. If it doesn’t, one can always try the king again.

Beyond this, I’m fascinated by the royal touch because it’s a vivid reminder of how slowly popular beliefs change. By 1660, we’re well out of the Medieval era. Literary scholars would say that the “Early Modern” period is past, leaving us (presumably) in the modern world. Yet many traces of the Renaissance belief in magic remain. It’s a time when confusing things can be explained by mystery and miracle. The English people believe in astrology, witchcraft, divination – and the healing touch of a divinely appointed king.