The Speckled Monster

She would never have been allowed near the sickroom, since she had not had the disease herself. Still in her father’s disgrace, however, she was barred even the comfort of holding vigil with the family. Pacing through her tiny rooms alone with dread coiling tightly about her heart, she had to await the few terse messages Lady Frances could smuggle out and finagle whatever else she could from Dr. Garth.

When word came at last, she sifted between the lines for hope: My brother, she wrote Wortley, is as well as can be expected. But Dr. Garth says ’tis the worst sort, and he fears he will be too full, which I should think very foreboding if I did not know all doctors (and particularly Garth) love to have their patients thought in danger. She refused to admit that her brother, not yet twenty-one, had already been pronounced beyond remedy. Six days later, on July 1, he died.

The howl that rose through her mounted in waves until she thought she must burst. Fists to mouth, she strangled her grief into a silent scream that she poured into her journal: Will had been her best and only natural friend, standing by her even as she found herself banished from the rest of her family for the sake of a man whose desire had frozen to disdain. His death left her worse than alone.

She had never seen the smallpox at work, but she had heard plenty about it and saw its scarring tracks everywhere. Spotted and blown like a carcass left in the sun, Will began to haunt her dreams. In her waking hours, her fears veered in the direction of Wortley: Your absence increases my melancholy so much I fright myself with imaginary terrors, and shall always be fancying dangers for you while you are out of my sight. . . . I am afraid of everything. There wants but little of my being afraid of the smallpox for you, so unreasonable are my fears, which, however, proceed from an unlimited love. If I lose you—she broke off and fought for control—I cannot bear that If, which I bless God is without probability, but since the loss of my poor unhappy brother, I dread every evil.

A week after her brother’s death, her husband had still finalized no plans to come south. Terrified for her new son and herself, Lady Mary fled north. While she stayed near York, searching for a suitable house, Wortley kept his distance, residing in bachelor’s quarters in the tiny borough where he was campaigning for a seat in Parliament. He insisted that she make all decisions about where and how they would live and grew irritated when she consulted him, even by letter. Then he questioned all her choices: of house, of coach and horses, of servants.

Wortley would have preferred the Sheffield area, but she chose the Italianate elegance of Middlethorpe Hall, just south of York. Shifting between Middlethorpe and London, Lady Mary whiled away a lonely year playing with her son and bickering long-distance with Wortley, who continued to flee every scene as soon as possible after her entrance.

The following summer, this dull run of affairs was punctured by two deaths and a wedding. At the end of May 1714, the dowager electress Sophia died in Hanover at the age of eighty-four, leaving her son George as Queen Anne’s heir. Two months later, on July 20, Lady Mary’s sister Lady Frances married John Erskine, earl of Mar, an unprincipled Scottish spendthrift fifteen years her senior. It was an inexplicable match—except as political insurance for Dorchester: Mar was a power among the Tory ministers of state. Lady Mary caught no whiff of the proceedings until too late to urge rebellion on her sister; she was not even in town when the ceremony took place. A week later, the queen fell ill. She had a rosy red rash, said the whispers; perhaps the scourge of smallpox had struck her family yet again. It had not, but that reprieve failed to improve her health. On August 1, 1714, Queen Anne died.

Up in York, Lady Mary saw George I proclaimed king amid fireworks, pealing bells, and rumbling fears of rebellion in favor of James Francis Edward Stuart, once the Whigs’ nemesis as the exiled Prince of Wales and now the chief challenger to George’s claim for the throne. The Pretender, the Whigs branded him. His followers they called Jacobites—after Jacobus, the Latin form of James.

With the kingdom on the edge of riots and his wife and child in direct path of Jacobite armies rumored to be massing in Scotland, Wortley remained in London, awaiting the new king. In the middle of September George arrived from Hanover to claim his new crown, and Wortley saw his star rise, along with the Whigs generally. He even began to gain ground in reconciling himself to Lady Mary’s father; by October 1, she could finish a letter to him saying, “My duty to Papa.” The Jacobite rebellion failed to materialize, but consumed by London politics, Wortley ignored his wife.

I cannot forbear any longer telling you I think you use me very unkindly, complained Lady Mary, still alone up in York in November. I parted with you in July, and ’tis now the middle of November. As if this was not hardship enough you do not tell me you are sorry for it. You write seldom and with so much indifference as shows you hardly think of me at all. You never enquire after your child.

At last, Wortley stirred himself to make arrangements for Lady Mary and their child to join him in London. I have taken a house in Duke Street, he wrote, near both the park and your father’s house.

She wrote back in a dither. The houses in that street were damp and falling down, she said. In particular, she hoped he had not taken the house of his cousin, Mr. George Montagu, nephew and heir to Lord Halifax, her long-ago partner in rhyme.

To Mr. Edward Wortley Montagu, to be left at Mr. Tonson’s, Bookseller, at the Shakespeare’s Head over against Catherine Street, in the Strand, London.

6 December 1714

Pray let me know what house you have taken, for I am very much afraid it should be the one where Mr. George Montagu lived and in which Mrs. Montagu and her child both died of the small pox, and nobody has lived in it since.

I know ’tis two or three years ago, but ’tis generally said that the infection may lodge in blankets, etc., longer than that. At least, I should be very much afraid of coming into a house from whence anybody died of that distemper, especially if I bring up your son which I believe I must, though I am in a great deal of concern about him.

I have received your second letter, Lady Mary added to the bottom of the one she had already begun, and hope by your mentioning another house of Mr. G. Montagu’s that you have not taken that which Mrs. Montagu died in. I know of but one he lived in, in that street.

This time, her fears about smallpox were neither random nor irrational. It had come to seem a time-honored tradition for pestilence to shadow the start of each new reign; previously, the epidemics of starkest memory had been the plague. With cruel irony, King George came accompanied by the scourge that had set him on the throne: the smallpox. The disease never entirely departed from London, but before the last epidemic in 1710, there had been a lull for a dozen years, long enough for Londoners to grow complacent, dismissing it as the mere inconvenience of a childhood disease. Now, only four years later, it was back at full putrid strength, sending Londoners young and old scattering before it. Perhaps, rumor muttered, the spans between epidemics would go on dwindling until London bubbled with infection year in and year out.

Once, Lady Mary had tormented Wortley by withholding information in a time of smallpox; now he took revenge in selective silence. As to the child, he replied, if you do wrong about him, you will have no reason to blame me, for I desire it may be as you like best. You shall know by next post which of Mr. Montagu’s two houses we have taken, he promised. It is certainly not that which was thought in danger of falling.

The next post came and went, however, with no enlightenment, and Lady Mary began to despair. I hope you’ll take care to have the house all over very well aired, which I am sure is particularly damp in that situation. There should be fires made in all the rooms, and if it be the house Mrs. Montagu died in (which I hope it is not) that all the bedding (at least) be changed. Lady Mary Montagu got the smallpox last year by lying in blankets taken from a bed that had been laid in by one ill of that distemper some months before.

Finally, just before Christmas, Wortley told her what she wanted to hear: he was not, after all, consigning her to a stew of infection. I am very well satisfied about the house, she replied. Even so, she decided to leave their precious son behind in York, rather than expose him to the hazards of a cold journey or cankered city air. At the beginning of the new year, she set out alone for the brave new Hanoverian metropolis of London.

At twenty-five, Lady Mary was beautiful, witty, highborn, and wealthy. She had shackled herself to a husband so cold and remote that she nicknamed him Prince Sombre, but however stingy Wortley could be emotionally, he spared nothing where his reputation was concerned. They had a fine (if possibly infected) house in a fashionable part of town, and he supplied all the gowns and jewels proper to her station. So long as she did not disgrace him, he left her at liberty to do as she pleased. Even the smallpox seemed to bow in her presence and withdraw, waning to a faint glimmer of its former terror. In January 1715, the city spread itself invitingly before her, and she determined to enjoy it.

She acquired an invitation to hear a private reading by a poet her father favored—the rising poet of the age, some said. Having achieved quick fame for his Pastorals and a mock epic called The Rape of the Lock, Alexander Pope had taken up the greatest of literary dares: He had begun translating into English rhyme the sixteen thousand ancient Greek lines of the greatest of all classics, the Iliad.

Lady Mary admired his verse for its muscular symmetry, but the man who stood up to read in the leather-and-gilt hush of Lord Halifax’s library was as far from that description as possible. A slender four and a half feet tall, with a back twisted and humped, Pope was a victim of Pott’s disease, or tuberculosis of the bone. His detractors snarled that he was a venomous and impotent hunchbacked toad; he mocked himself as “that little Alexander that women laugh at.” He was edgy and his forehead was furrowed from chronic pain, but his large eyes snapped with glee.

Lady Mary knew why, for Mr. Congreve and Dr. Garth had let her in on a jest in progress. The previous fall, at Pope’s first reading-in-progress of the Iliad, Lord Halifax had interrupted the poet several times to proclaim, “I beg your pardon, Mr. Pope, but there is something in that passage that does not quite please. Be so good as to mark the place and consider it a little at your leisure. I am sure you can give it a better turn.” Afterward, Dr. Garth had dared the fuming poet to read the same passages over a few months hence, only pretending to have changed them.

The smothered merriment that burst out later at the postreading celebration in the studio of Pope’s friend, the portrait painter Charles Jervas, whirled Lady Mary into the heart of London’s literary and artistic elite. Soon, at the challenge of Pope and “Johnny” Gay, she undertook to write a series of seven town eclogues, one for each day of the week, satirizing high society. Peccadilloes in the bedroom, vanity at the dressing table, and folly at the card table: she relished the absurdity of wealthy London’s minor sins.

Poets and artists did not occupy all her time: she was also in demand in the highest circles at court. At fifty-five, the king was a handsome man with china-blue eyes, long, fine fingers, and a long nose. As a monarch, he was conscientious and demanding, though not brilliant. As a man, he was a quiet, domestic sort who liked to spend time with family and close friends; he was also a deft storyteller who liked a good, earthy joke. He did not, however, speak more than about ten words of English, and never attempted to learn. For him, German and French were enough.

In part because she could join in the French raillery, Lady Mary soon became one of very few English ladies regularly invited to the intimate supper parties hosted by the two ladies known as “the king’s women”: his tall, angular, and slightly gawky forty-eight-year-old mistress, Melusine von der Schulenberg, and his portly half-sister, Sophie Charlotte von Kielmansegg. The Maypole and the Elephant, as they were known to the more irreverent wits frisking about the palace.

Though Lady Mary was duly grateful for the weight of the king’s eyes upon her, the parties that seemed so relaxed and homely to him seemed to her excruciatingly brittle and dull. One evening, as the Maypole made the king chuckle by snipping caricatures of his courtiers out of paper and the Elephant sparred over some obscure phrase in Mr. Locke’s philosophy, Lady Mary had to clench her jaw to keep from screaming with boredom. Her only partner in small high-jinks was thirty-year-old James Craggs, fast rising in the ranks of power due to formidable talent in the council room and an equally formidable talent, it was rumored, in the bedroom. Tonight, he was late; as a result, Lady Mary had been marooned at a card table with three Germans so staid they might as well have been stuffed. Half an hour later, she gave up on Mr. Craggs and dared to contrive an escape.

“C’est injuste,” complained the king in his heavily German-accented French as La Schulenberg delivered Lady Mary’s request to withdraw early, along with an indulgent recommendation to grant the young lady mercy. “Absolument perfide,” he added, gazing down at Lady Mary’s black hair and creamy décolletage as she sank into a curtsy. “It is unfair, absolutely perfidious, my lady, that you should cheat me of so charming a presence in such a disloyal manner.” It amused him to tease her, engaging her in inventing ever more rococo apologies. Not until he saw that she was no longer certain whether he was teasing—perhaps she had really irritated him—did he allow her to depart. Or desert, as he maintained.

Released, she flew with quick pattering steps down the grand marble staircase of Kensington Palace, her gown billowing behind like wings, brushing against the dark curlicues and leaves of the wrought-iron balustrade. She was glancing over her shoulder, as if pages even now might be chasing after her to call her back, when she ran hard into someone at the foot of the stairs.

“Oh, Mr. Craggs,” she gasped. “No. It is just that I have had prodigious trouble in coaxing the king to let me go.” Up this close, he was even more handsome than generally allowed, though some affected to scorn his broad-chested exuberance as more proper to a porter than to the whipcord beauty of the ideal courtier.

Suddenly Mr. Craggs tossed her over his shoulder and leapt upward two and three stairs at a time. No amount of pounding on his back slowed him even a jot; in any case, she was giggling too much to do any real damage. At the arched entryway to the king’s apartment, he set her down, ostentatiously kissed both hands, and disappeared without a word. Before she could so much as shake out her crumpled skirts and smooth her hair, the bewildered royal pages flung open the doors and reannounced her.

There was nothing for it but to curtsy and rejoin the party. “Lord, sir!” she exclaimed as the king raised her up. “I have been so frightened!” Laughing breathlessly, she regaled the company with a lively rendition of Mr. Craggs’s prank. Amusement played around La Schulenberg’s lips, but the king’s older friends gravely shook their heads; the young British were not merely undignified, they were altogether hooligans.

“Mais comment donc, Monsieur Craggs,” bristled the king, laying a possessive hand on Lady Mary’s shoulder, “est-ce que c’est l’usage de ce pays de porter des belles dames comme un sac de froment?” Is it the custom in this country to haul fair ladies about like a sack of wheat?

“Bloody hell!” Craggs swore in Lady Mary’s ear. “Do you possess so much as a single drop of discretion?” He had done her a great favor, he made it bitterly clear, keeping her in the king’s favor; in return, she had painted him to the king as a rival.

The king, thought Lady Mary, was a bit of a blockhead, but she liked him for all that. His son was another matter. George, Prince of Wales, she deemed a mean-spirited prig. “He looks on all the men and women he sees as creatures he might kick or kiss—for his diversion,” she sniffed to her sister. Soon, however, Lady Mary was drawing the prince’s eyes as well as the king’s.

One evening, the prince called his wife away from the card table to see how charmingly Lady Mary was dressed. Caroline of Ansbach, Princess of Wales, came as called, but failed to share his raptures. “Lady Mary always dresses well,” she observed dryly, returning abruptly to her cards. Soon after, the prince was made aware of Lady Mary’s regular attendance at his father’s supper parties. Directly, despite all her fine dressing, his ardor not only cooled but curdled; he could no longer see her without taunting her as a deserter gone over to the enemy’s camp: throughout the eighteenth century, Britain’s kings and their heirs competed jealously for power, splendor, loyalty, and sometimes women.

On the ninth of August, the day after Lady Mary’s sister Frances—now the countess of Mar—gave birth to their first child, the earl her husband disappeared, leaving her without money or any notion of where he might be going. On the tenth, Lady Mary’s father was promoted yet again, reaching the pinnacle of the peerage as the first duke of Kingston.

Frances was sworn by her husband’s family not to discuss any of her difficulties with her father, but, reduced to selling jewels, plate, gowns—everything of value—she had obviously been left penniless. The earl of Mar soon turned out to be far worse than a wayward husband: he had absconded for Scotland to head the Jacobite armies of the Pretender. The rebellion that had been festering since Queen Anne’s death at last broke into the open, and the new duke of Kingston found that instead of acquiring political insurance in the form of a Tory son-in-law, he had saddled the family with one of the chief Jacobite traitors.

In mid-November, Jacobite and loyalist armies clashed in Scotland at the Battle of Sheriffmuir. The Hanoverians claimed victory, but for all its ferocious slaughter, the battle was indecisive. Inept even in treason, Mar unintentionally helped his Hanoverian foes by failing to seize any of the many advantages his army had been left with. In the following weeks, however, the Pretender himself was expected to land any day and galvanize the rebel army into a far more dangerous force. All Britain hushed and hunched down, poised to leap into the carnage of another civil war.

The anxiety of it all exhausted Lady Mary. One afternoon in mid-December, she withdrew early to her chamber. Lying in her stately four-poster bed, canopied and draped in embroidered brocade, she was unable to sleep. The chambermaid must have stoked the fire with enough coal to heat all of Sweden. Tossing and turning, she kicked the bedclothes off. Directly, she shivered and pulled them back up. At last, her head pounding and her skin burning, she rose to drink in cold air at the window, but when she stood up, the room spun. She could barely stagger to the washbasin before she began vomiting.

Still reeling, she called her maid and had young Edward and his nurse packed out of the house without waiting for daylight. By morning, her fever had dipped a little, but her back throbbed dully and her headache intensified until she thought the front of her skull must be clapping open and closed like a loose shutter in a storm. As the sun climbed in the sky, her fever turned around and soared ever higher.

Richard Mead and Samuel Garth, both royal physicians and members of the Royal Society—and Dr. Garth a longtime friend in the bargain—were sent for. But Lady Mary guessed what was wrong long before she heard their coaches halt at her door. After all her running, the demon smallpox had finally caught up with her—as it happened, very close to the same day that it had caught Queen Mary, twenty-one years before.

The two doctors tended toward agreement, though they would confirm no diagnosis before the telltale rash. They ordered her bled, to which she submitted though she detested it, and prescribed both a “gentle” vomit to empty her stomach, and a purge, or laxative, to empty her bowels. Four times a day, they poured down her throat a medicine only a half-step away from magic: two parts powdered bezoar—or ground-up “stones” of calcified hair and fiber found in animal stomachs and valued since ancient times as an antidote to poison—and one part niter, or saltpeter—one of the chief ingredients of black gunpowder. This mixture, Dr. Mead intoned, leaning on his golden-headed cane, was “to keep the inflammation of the blood within due bounds, and at the same time to assist the expulsion of the morbific matter through the skin.”

Snow already blanketed the cobblestones of Duke Street below her window, but grooms padded them further with straw. Smallpox, Dr. Mead announced outside her door, was a dangerous effervescence of the blood. Lady Mary, advised Dr. Garth, his eyes fixed upon Wortley, was therefore to be kept from any commotion, confabulation, and passion—whether grief, love, or fear—that might further stir up the poison boiling inside her.

Despite the hushed tiptoeing around her bed, her mind grew restless with a strange, brilliant clarity, as if she had previously been imprisoned in a cloudy crystal ball that some unseen hand had suddenly wiped clean. She could not sleep, but the doctors refused her any opiates, so she chattered through the night, the nurses nodding off as the candles guttered in the darkness.

The next morning, the fever began to fall, though her skin was still hot to the touch. Soon, tiny red flecks no bigger than pinheads and smooth with the surface of her skin sprinkled across her forehead. Hour by hour, they flowed down her body from the top of her head to the tips of her toes, as if some fiery-eyed destroying angel stood caught out of time behind her bed, the hot wind from his wings blowing a slow-motion storm of red sand across her. Even as the flecks drifted downward, those that had appeared first began to rise into hard little bumps. They neither itched nor hurt, but when she rubbed them, they rolled like shot scattered beneath her skin. This time, no diagnosis of measles would rescue her. She most certainly had the smallpox; the only question was what kind.

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.

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.

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.

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 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.

She would not look like that, anymore. “It would make a man weep to see what she was then, and what she is like to be, by people’s discourse, now”: so the diarist Samuel Pepys had mourned in 1668, standing before two portraits of Frances Stewart, duchess of Richmond and breathtakingly beautiful mistress of King Charles II. He had gone in his coach to stare at the paintings four days after the whispers had scuttled through London that Richmond—like Lady Mary more recently—was “mighty full” with the smallpox. The duchess would live, they murmured, but “wholly spoiled.”

Only a little more than a month ago, another king had been casting his eye upon Lady Mary, and the whole world seemed to lie in raptures at her feet. From what she had gleaned lately, that would no longer be the case. When she asked Dr. Garth about her face, he had set aside his frown and pronounced with forced cheer that she would again be fair, but she hadn’t trusted him since her brother died. Others who had clustered around her bed, clucking sympathetically, had been more circumspect.

The face she saw was unrecognizable. Though the swelling had gone down since the worst of the crisis, her fine, long nose was still bottle shaped, her lips thickened and cracked. Her eyelids were puffy and her eyelashes had all fallen out. The last time she had glanced in a mirror, her skin had glowed like translucent ivory; now she saw deep, twisted craters stained a splotchy reddish brown, as if someone had slapped over the face she knew a thick, poorly modeled mask of discolored, clotted papier-mâché. At least Mr. Wortley, she thought bitterly, would be satisfied. Once, he had wished she might lose her complexion so that she might also lose some of her admirers; smallpox had finally granted his wish.

She called her maid back and handed her the mirror. “Take that picture out of my sight,” she said, nodding at the Kneller. Before I tear it, she thought—though, really, it would take a full-fledged knife-throwing brawl to make the face once again match its disfigured original. As the maid staggered away with the painting, Lady Mary did what she always did in distress: she rose, crossed to her desk, and picked up a pen.

For almost a hundred rhyming lines, a new eclogue spilled through her pen, full of self-mockery. Once, she had spent hours at her dressing table, deep in happy debate about the fall of curls and the exact placement of beauty patches. Opera tickets, perfume, Japanese lacquer, and flowers had all been strewn at her feet. Statesmen, soldiers, beaus, wits, gamblers, and country squires had vied for a kind glance; she had herself paused on her way out the door, to appreciate the figure in her mirror. But “now,” sighed Lady Mary, “beauty’s fled, and lovers are no more.”

But it was not just that admirers had fled, she mused; her enemies were stepping out of the shadows to take their place. When it was thought she would die, someone showed another of her eclogues to the Princess of Wales, whose court it lampooned. As it became clear that Lady Mary would live, her enemies crowed over what this impolitic bit of poetry might do to whatever shreds were left of her court career. “She will be pitted but not pitied,” tittered the many ladies who despised her.

Her friends had carried these insults to her like some foully titillating bouquet, expecting her to hurl sharp quills of revenge, but Lady Mary was less concerned about Caroline than the king: the face she had seen in the mirror was no delicacy to delight a monarch. Titles, offices, lands, and palaces: these were sugarplums that fell into the laps of kings’ playfellows, all now slipping away like the white silk remnants of a dream. . . . Wortley would not be pleased about that, at least. But he would not be the only one watching either. She winced, knowing that the snake den of London society—friends and enemies alike—would stare in fascination as the king’s attraction for her went slack and began to feather elsewhere. Pitted, but not pitied, indeed. Her pen began to scratch across the paper once more:

Cease hapless maid, no more thy tale pursue,
Forsake mankind, and bid the world adieu.
Monarchs and Beauties rule with equal sway,
All strive to serve, and glory to obey,
Alike unpitied when depos’d they grow,
Men mock the idol of their former vow.

Her reverie was interrupted by the arrival of Dorothy, Lady Townshend—as innocent, imprudent, and flittering as her brother Sir Robert Walpole was careful and cunning, and long one of Lady Mary’s closest confidantes.

Dolly caught her breath as Lady Mary turned unmasked toward the door. “Oh, Mary,” she cried, crossing the room to take her friend’s hand. “You have lost more loveliness than I ever saw in another face.”

Lady Mary sighed, set down her pen, and rang for tea. At least Dolly was honest. “’Tis certain, dearest Dolly, that I have lost what beauty I had—just when I was beginning to realize its advantages.”