The Speckled Monster (11 page)

The next day, the spots went on growing in size and deepening in color, gathering most densely on her face, forearms, and hands. All the while, her fever went on falling, until she felt almost well. Perversely, Dr. Mead and Dr. Garth grew graver with every visit. What they knew but did not tell her—still guarding against fear—was that her rash was already quite thick. At this early stage, that was a dangerous sign.

 

In the eighteenth century, as in the twentieth, doctors distinguished four main types of smallpox, though they labeled them with different names and distributed them with different logic across the branches of the smallpox family tree. Everyone who dealt with it realized that the best of this bad disease was “distinct” or “discrete” smallpox, which presented a rash scattered thinly enough so that the pocks remained separate—or distinct—with patches of normal skin in between. In “confluent” smallpox, sometimes called “coherent,” the rash was so dense that across much of the body—especially the face, hands, and forearms, where it was always thickest—the pocks ran together into one huge festering sore; little to no normal skin was left. In everyday terms, these victims were said to be “very full.”

The remaining two types—flat and hemorrhagic—were once often lumped together (sometimes with confluent) as “malignant smallpox.” In “flat,” “crystalline,” or “warty” smallpox, the slow-growing blisters usually ran together, but never really rose much above the surface of the skin and did not fill with the same kind of thick yellow pus found in discrete and confluent pocks. Instead, shallow ripples spread across the skin's surface, stretched over sores buried in its deepest levels; large strips of the top layer of skin, along with the delicate coverings of most mucous membranes (inner nose, mouth and throat, anus, vagina), eventually just sloughed off. Almost three quarters of these cases were children under fourteen.

Hemorrhagic smallpox was subdivided into two kinds, “early” and “late,” both marked by profuse bleeding at every orifice, as mucous membranes and blood vessels seemed to melt away. In the early type, once known as “the purples,” death came before any pocklike rash broke out, though the skin transformed to dark purple velvet. In late hemorrhagic smallpox, victims survived long enough for blisters—often flat in type—to appear, but they quickly filled with blood, darkening to bruised purple and black, ringed with red. In both kinds of hemorrhagic smallpox, it was not the bleeding, but heart failure or fluid in the lungs (pulmonary edema) that proved the immediate cause of death. Nearly all these cases were adults; two thirds were women.

These malignant cases were relatively rare (just over 9 percent of the total number of smallpox cases), but they were death sentences so terrible to behold that they loomed monstrous in the imagination. Flat smallpox carried about a 3.5 percent chance of survival; in late hemorrhagic smallpox it was 3.2 percent. Early hemorrhagic smallpox had no survivors.

Eighteenth-century doctors saw these malignant types as crop failures. Flat and purple smallpox did not ripen properly, while confluent cases quickly grew overripe. Twentieth-century doctors explained all three of these serious developments as the results of differing degrees of immunodeficiency; some people with otherwise healthy immune systems inexplicably had little to no power to fight back against the variola virus. As early as the seventeenth century, it was known that such weakness in the face of smallpox ran in families—the Stuarts, for example. Pregnancy was another high-risk factor, already obvious to early doctors.

 

In Lady Mary's sickroom, the first days sped by in pairs. The first prerash fever had been much the most uncomfortable stage so far. As the red spots flowed down her body across the following two days, she began to feel better. With her fever still falling, she felt better still as the spots bubbled into blisters for another two days. “How is my boy?” she kept asking.

“Still unspotted,” came the answer.

The same could no longer be said for her. As she watched, the red bumps filled with a clear liquid that gradually thickened to opalescent grayish white; now they began to look like large flat pimples that might be called “pocks.” A ring of red circled the base of each one, while their centers sank in a small dimple.

At last she saw what the doctors had been quietly worried about: hour by hour, the pocks went on growing, running into each other until large sections of skin looked to be covered by a single marbled blister. She could not see it, but her face swelled so much that her finely carved features began to submerge, the skin pulling taut over nose, ears, chin, and cheeks; her eyes squeezed into slits. Those who did glance at her face thought she looked unnaturally old or young: the disease was transforming her into a grotesque gigantic changeling, wrapped in a tight gray caul that veiled all her features.

At last, the doctors issued a diagnosis: she had the confluent smallpox. The news skittered around London and winged north to the armies burning Scotland:
Lady Mary is exceedingly full and will be very severely marked
.

 

However much they irritated her, Lady Mary was lucky in having Dr. Mead and Dr. Garth at her bedside. Besides being known for compassion, they were both moderates in an age when medicine was unabashedly aggressive; in attempting to be heroic, it was more often horrific.

A very few practical men had begun systematically observing their patients and describing symptoms that clustered into specific maladies. The most eminent physicians of the day, however, were abstract philosophers who snipped and stretched experience to fit theory, in their case a modified version of the ancient Greek theory of the four humors. Good health, in this system, was a perpetual circus act, balancing ever-shifting quantities of blood, black bile, green bile, and phlegm, as well as the oppositions of hot and cold, moist and dry. Imbalances tipped people into the morass of sickness; restoring a patient to health meant bringing them back into balance.

To do so, doctors tried to relieve whatever the body was producing in too much abundance by either repressing or removing it, while nurturing the growth of whatever they judged to be lacking. It was the relief side of this equation into which medicine had long put most of its efforts and its faith—though
relief
proves a bizarrely inopportune word for their ministrations.

Any and all possible bodily emissions were sometimes thought necessary to force. The most commonly practiced “evacuation” was bloodletting: slitting veins open at the wrists, arm, groin, or in serious cases, the jugular, to let poisons escape with the blood. If all else failed—or, in the delicate cases of infants, right at the beginning—doctors applied leeches to the temples or behind the ears. They also induced sweating, salivating, and blistering, and they administered clysters, or enemas, and ferocious laxatives and diuretics. An unholy array of emetics produced immediate and sometimes prolonged vomiting. Many, if not most, of the medicines they put into a body were designed to send something else shooting out of it, making eighteenth-century medicine a leaky, spraying, spewing art.

It was an art, furthermore, divided into three territories with jealously—though often unsuccessfully—guarded boundaries. Physicians were university men with medical doctorates. High (and highly expensive) priests of the mysteries of diagnosis, they solemnly prescribed treatments but rarely provided them, though things were changing in progressive and ruthlessly practical places like Edinburgh, or the University of Leiden over in Holland. In London, any procedure, such as bloodletting, that involved cutting was still by law the purview of the surgeons—historically, a specialized branch of the razor-bearing brethren of barbers, with whom they shared a guild until 1745. In contrast to the learned doctors, a surgeon was a mere “Mr.” who learned his trade by apprenticeship. The men who concocted the potions and powders that physicians prescribed were the apothecaries, or pharmacists. Scurrying through the cracks in this system was an army of panacea-peddling quacks, mountebanks, and empirics.

Wealthy patients not only paid all three of the proper medical professions to dance attendance at their sickbeds: as a kind of status symbol of conspicuous consumption, they consulted multiple physicians. Poorer people made do with surgeons, apothecaries, local wisewomen or nurses, and the potions of the quacks: and were often better off for it.

Lady Mary was neither stifled with blankets, nor frozen with drafts of the bitterly cold December wind. Instead, her room was kept as pure and cool—but not frigid—as possible. She was fed a meager diet of oatmeal and barley-gruel. In the beginning, the cooks were directed to boil preserved figs, plums, and tamarinds with her gruel, to keep her “open and cool.” To drink, she had mild diuretics: small-beer “acidulated” with orange and lemon juice, and sweet German wine thinned with water.

Every two or three days, the surgeon arrived to bleed her: to relieve the poison boiling over in her blood. Even this was moderate. Some physicians, sniffed Mead, were terrified to bleed at all, while others could not be stopped: when the virtually unkillable King Louis XIV of France had had smallpox, he was bled ten or eleven times in a matter of weeks.

 

A week after she had fallen ill, her fever was almost down to normal. Bored with illness and still fretting over her child, she claimed she felt fine, but the doctors would not let her get up. Across the next four days, the gray liquid inside the pocks went white and congealed to beeswax-yellow pus; the rosy rings around their bases faded. Still, though Lady Mary would not have thought it possible, the pocks went on growing. Her distended skin began to hurt. The sores glued her upper lip to her now bottle-shaped nose, and her face grew blank and bored as her features disappeared beneath the swelling. Her peglike fingers could no longer wield a pen. Her mouth, too, was filled with sores, along the tip and sides of her tongue, the roof of her mouth, and the back of her throat. Just as it became agony to swallow, saliva gushed out in rivers.

For a while, she managed the single rasping word,
“Boy.”
Then even that was scraped from her, and the world collapsed into a narrow battle to survive.

On the eighth day of the rash, the tenth of her illness, her period gushed out early, ruining the sheets in a flood more like a hemorrhage. Her fever spiked back up to the heights it had reached in the first two days. Worst of all, some of the pocks began to burst, emitting a cadaverous stench.

Like the queen before her, she had made a quick, cursed journey from beauty to beast, no longer fit to delight the eyes of a king. She might be too sick to know it, but others were riveted from one end of the kingdom to the other:
Poor Lady Mary Wortley has the small pox,
gossiped James Brydges, earl of Carnarvon, to a friend fighting in Scotland,
just as it began (to her great joy) to be known she was in favor with one whom every one who looks on cannot but love. Her husband, too, is inconsolable for the disappointment this gives him in the career he had chalked out of his fortunes
.

“With a pair of good eyes like Lady Mary's, being marked is nothing,” Lady Loudoun scoffed to her husband, also with the army in Scotland. Complexions, she commented archly, could be bought.

Eleven days in, Lady Mary 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 even higher, hovering between 103° and 105°—though they did not then measure temperatures so exactly, relying on touch. She slid in and out of delirium. Most ominously, her breath began to rattle in her chest. In confluent smallpox, it was this secondary or “suppurative” infection caused by reabsorbing all that pus—or else pneumonia triggered by the infection of the airways—that killed.

For two days across Christmas, whispers slid through the drawing rooms: Lady Mary would die.

While she fought for her life, the whole kingdom held its breath and peered northward, wondering about its own survival: on December 22 up in Scotland, the Pretender landed at last.

 

For Lady Mary, the crisis receded as suddenly as the disease had sprung forth. Just before dawn on the fifteenth day, her fever broke.
“My son,”
she whispered, as the world settled back into place around her. “Safe,” began the nurse, but that was enough. Lady Mary sank into a deep, healing sleep.

Slowly—maddeningly slowly—the scabs dried and began to fall off. By the end of the first week of January 1715, the swelling was subsiding and the rattling of her breath was gradually growing mute. Most of the dark crust that had covered the rest of her body had crumbled away, though the dark-brown “seeds”—or imbedded scabs—of smallpox still lay buried in the palms of her hands and soles of her feet. She would live; that was now clear. What kind of life might be in store for her, though, was not.

They had veiled the mirrors on her walls and dressing table when she first fell ill, and no one had as yet made any offer to uncover them. By the twisted red pits that now mottled her still swollen hands and arms, she was not sure if she wanted them to.

Curiosity and dread plucked her mind this way and that. At last, she asked her maid to bring her a hand mirror and then sent her away again. Reclining on a couch, her face hidden beneath a silken mask, she could see frost dancing in filigreed designs across the tall windows. Snow thinned daylight to a pale, downy blue; even so, the light made her eyes ache.

She kept the mirror carefully reversed, playing fitfully with the light that careened off its surface and shattered against the far wall. On that same wall gleamed the portrait that Sir Godfrey Kneller, the finest painter in the kingdom, had finished of her only a few months ago. In his hands, the ivory sheen of her gown set off the creaminess of her face, breast, and hands. As a matter of course, he had caught the likeness of her delicate features; more mysteriously, he had also caught the shine of intelligence in her eyes, and wicked merriment in the pointed arch of her brows, inherited from her father.