The Speckled Monster: A Historical Tale of Battling Smallpox

Reviewer: John S. Marr, MD, MPH

Disclosures

May 07, 2004

By Jennifer Lee Carrell
E. P. Dutton
Copyright 2003
474 pages
ISBN: 0-525-94736-1
$25.95 hardcover

When factional tales deal with real epidemics, one would expect that the medical information presented is assiduously researched because a single mistake may crack credibility and suspension of belief. English novelist Daniel Defoe did this quite well, even at a distance of 55 years, in his faux diary accounts of the 1665 London plague. Similarly, French-Algerian writer Albert Camus was accurate in his clinical descriptions of disease in his novel The Plague.

In contrast, the biopic movies about Paul Ehrlich and Louis Pasteur, although filmed within a few decades of their deaths, redacted history and oversimplified their lives and the diseases they investigated.[1,2] Recent novels have also devised fact and revised history, creating whole, cloth fictional accounts of John Snow and Typhoid Mary.[3,4]

The same cannot be said for The Speckled Monster: A Historical Tale of Battling Smallpox. Jennifer Lee Carrell's book belongs with an elite list of historical novels dealing with eighteenth-century Europe and its colonies. Like Kenneth Roberts and Patrick O'Brian, Carrell has meticulously researched her topic. Having received her doctorate in American and English history at Harvard University, Cambridge, Massachusetts, and having contributed to Smithsonian magazine, Carrell is up to the task of inserting accurate and complex medical citations into a sweeping tale of conflicting beliefs. There are 45 pages of notes at the end of the saga that explain what happened to the characters after 1721-1725 when confrontations were largely over. A 25-page Source and Bibliography with well over 200 references (most of which are primary sources) testify that the author has steeped herself in historical data. And, for the reader's sake, these citations are not placed at the bottom of each page -- something that would have destroyed the narrative flow. With rare exception these documented facts do not intrude into the pace of the novel.

The plot details the first use and subsequent controversies that ensue after a proto-case-control experiment is performed in England and a separate decision is made to use variolation in Boston to protect citizens against an ongoing epidemic (the speckled monster of the title being an early nineteenth-century term for smallpox). There are a number of factual subplots involving court intrigue, sinister subterfuge, allopathic squabblings, political and religious differences to sustain the reader, and an equally satisfying denouement in which the 2 proponents of variolation meet in 1725 after the tumult and the shouting had died.

Dutton's press release and the book's dusk-jacket summary suggest that the novel has 2 heroes: the very English Lady Mary Wortley Montagu and the contrarian American physician Zabdiel Boylston. But there are other heroes as well as villains, including somber English physician, Charles Maitland; the Princesse Caroline, Princess of Wales; waifish prison volunteer, Lizzy Harrison; crippled poet, Alexander Pope; a fustian, pre-Dickensian character, Dr. Wagstaffe; and the elflike, aging Sir Isaac Newton. In Boston there were also the dour Reverend Cotton Mather; Boylston's steadfast wife, Jerusha; the truly heroic and tragic Captain John Gore; the froward Dr. William Douglass; and a young gadfly, Ben Franklin.

Indeed, the novel is filled with many other Dickensian characters (most of whom are real) and Dickensian descriptions and vocabulary. One hears it in Carrell's description of the standard medical treatment for smallpox: bleeding, "gentle vomit, a purge, a laxative, a bezoar, and saltpeter...in order to assist the expulsion of the morbific matter through the skin" (p. 47). Carrell uses amusing archaisms (frippery, flibbertigibbet, flummgummarie, and joukerypawkery), and she follows twisted subplots leading up to the fateful year 1721 when modern immunization history began -- some 80 years before Edward Jenner.

As Carrell's work follows the subplots leading up to the year 1721 when modern immunization history began -- some 80 years before Edward Jenner -- she shows that a meticulous historical account leading up to the introduction of variolation is needed for no other reason than to document its impact on the world. Variolation was, in Thomas Kuhn's term, a momentous "paradigm shift" -- when a single observation leads to an intellectual upheaval in thinking and transforms scientific perspective forever.[5] Yet, historians have not given proper accolades to Montagu and Boylston, favoring Jenner. Two definitive, historical works on eighteenth-century smallpox outbreaks give but passing citation to these 2 figures.[6,7]

Carrell carefully explains the variolation procedure in detail, as well as its routine sequelae, and grisly untoward reactions (No vaccine adverse event reporting system [VAERS] reports were ever submitted). The signs and symptoms of smallpox are movingly recounted in its victims, transcending any contemporary textbook description:

Eleven days in, Lady Montagu entered the critical stage of confluent smallpox. In places, strips of skin peeled away; elsewhere, boils erupted as secondary infections attacked the raw, stagnating wounds. A brown crust crept over her whole body; from under the scabs leaked pus stained rust with blood. What little was left of her skin felt sheeted in flame as her temperature jagged higher... (p. 52)

One has only to read The Journal of the American Medical Association's "JAMA 100 Years Ago" to observe that 1 generation's cure is the next generation's quackery. Carrell's tale provides an excellent reminder of this; the best and the brightest of any century -- English dons and Harvard's best -- may use established orthodoxy and intellectual arrogance to stifle what is perceived as quackery. However, The Speckled Monster also demonstrates that heroes can prevail and that a historical narrative about disease can be highly entertaining and heuristically educational.

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