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Smallpox: The Long Rampage of ‘the Speckled Monster’

By Frances Reynolds, author of In Sickness & In Health

In the first half of In Sickness & In Health, the primary antagonist is not a person, but something very different. A microbe: variola major.


Smallpox was a terrifying viral disease which moved through the human population for thousands of years until it was declared eradicated in 1980.

Yes, 1980. As of this writing, a mere 43 years ago. Many of us were already around by then! Quite a few of the adults I knew growing up had the distinctive scar of smallpox vaccination on one of their arms.

In 18th century Europe, about 400,000 people--rich, poor, and royal--died from smallpox each year. Although never a dominant theme in Jane Austen’s writing, the awareness of mortality and the possibilities of unexpected viral and bacterial diseases must have been a constant in her life. (Jane herself records a day in November 1800 spent listening to Edward Jenner’s pamphlet on cowpox.) In 1783, Jane and her sister, Cassandra, contracted typhus while at school in Southampton; their aunt Jane Cooper, arriving to remove the girls and her own daughter, also fell ill with the disease and died.

As for smallpox, Jane’s niece Caroline Austen provides an account of an epidemic that broke out in 1775 in the village of Enborne, scarring her mother, Mary Lloyd, and killing Mary’s seven-year-old brother, Charles.

The smallpox was brought into the house by the coachman, who concealed the fact, till too late, that it was in his own cottage. My grandfather, when it broke out at the Rectory, separated himself from his family, and took lodgings . . . not to carry the infection into church on Sundays. The children had never been inoculated—I know not whether from any superstitious scruple on the part of their parents, or from a negligent delay.

The first signs of smallpox infection were fever and vomiting; mouth sores and a rash follow. Soon the rash would turn to fluid-filled bumps with a tell-tale dent in the middle. Sixty-percent of those with significant exposure to the virus—meaning, prolonged contact with an infected individual—would contract it unless they had been vaccinated or survived it previously. Of the more fortunate 40%, it is now believed that an unknown but possibly significant portion had a small genetic mutation known as CCR5 deletion, which is protective against certain RNA viruses including smallpox and HIV-1; this mutation may even be an evolutionary response to smallpox.

Of those who fell ill, about a third—and up to 80% of children—would die, while those who survived were left with scars ranging from mild to severe. Some were wholly or partially blinded; in small children, the virus could enter growing bones, causing severe pain and even limb deformities.

Then, as now, the best defense against serious infectious disease was vaccination, more commonly called inoculation at that time. Inoculation was first practiced in China as early as the 10th century. Knowledge of the procedure did not make its way to Europe until the early 18th century, however. In 1796, the English physician Edward Jenner developed a new smallpox inoculation method using the relatively benign cowpox virus, and coining the word ‘vaccine’ to describe it. In 1813, Caroline Austen was re-vaccinated by Dr. Jenner, but unfortunately for many, smallpox vaccination in England would not become widespread in until the mid-1800s.

While vaccination did not confer complete immunity, those few who contracted the disease afterwards invariably displayed a mild form that was often mistaken for chicken pox. This we know with the benefit of hindsight, and at the time of our story the true efficacy of the procedure was not yet understood. This is partly, perhaps largely, because the mechanisms of infectious disease were not yet known: the first proof of bacteria as a cause of disease was published in 1876, and the first virus was identified in 1892. Prior to these breakthroughs, though vaccination worked, no one really knew why.

Though smallpox was eradicated in the 20th century, more than 300 million people died of the disease between 1900 and 1980. It is thought to have emerged in human populations circa 10,000 BCE, and almost certainly killed over a billion in the course of its long history.

The sudden rise of COVID-19 in 2020 taught us that even in these modern times, with modern medicine, our bodies are vulnerable to disease on epidemic, and even pandemic, scales. I imagine that in Jane Austen’s time such crises were got through much as we faced the crisis months of COVID-19—with a reliance on family and friends and the best that medical science had to offer, by reaching inward to find their own strength, and sometimes just by standing up and soldiering on.

I hope that, should you choose to read In Sickness & In Health, you will find some pleasure in seeing her beloved characters confront and, at least in part, triumph over a crisis that is not entirely unlike the one so recently unleashed upon us.


Image Sources:

Variola major, the smallpox virusCopyright: (c) Eye of Science / Science Source

“The Cow Pock.” 1802 caricature by James Gillray of Jenner’s vaccine. Wellcome Images, licensed under the Creative Commons Attribution 4.0 International.

Wikimedia: Coloured etching by I. Cruikshank, 1808, of Dr Jenner and his two colleagues seeing off three anti-vaccination opponents. The caption reads "Vaccination against Smallpox or Mercenary & Merciless spreaders of Death & Devastation driven out of society!"

Smallpox lesions on hands:

Bust of composer Christoph Gluck by Jean-Antoine Houdon, displaying Gluck’s pockmarks from smallpox

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Jul 13, 2023

I am now reading this story and, yes, I too have a scar on my upper left arm from my smallpox vaccination.


Dominique Aubry
Dominique Aubry
Jul 12, 2023

A synthesis document very interesting.

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