From Publishers Weekly
Long before vaccination for smallpox was developed in Europe in the 1790s, people in the Middle East, the Caucasus and Africa knew that small amounts of live smallpox virus injected under the skin would induce a mild form of the disease that rendered a person immune from full-blown smallpox. In her intriguing book, Carrell, a writer for Smithsonian magazine, switches between the stories of two courageous people in early 18th-century England and America who believed passionately in this procedure, called variolation. While living in Turkey, Lady Mary Wortley Montagu, herself disfigured by the disease, had her son inoculated. When she convinced her physician to inoculate her daughter during a smallpox epidemic in London in 1721, public opinion was vehemently against her but, after the procedure appeared to work, physicians persuaded King George I to let them experiment on prisoners who agreed to submit to variolation in return for pardons. In Boston, also ravaged by smallpox in 1721, Zabdiel Boylston, a physician who had survived the disease, learned of variolation from slaves and successfully inoculated his own children. The authorities ordered Boylston to stop the practice, and outraged citizens even tried to kill him, but he persisted, encouraged by a few believers, including the influential Puritan clergyman Cotton Mather. In Boston, as in London, most people who underwent the procedure didn't get full-blown cases of smallpox, and variolation was finally accepted as the only way to protect against the disease before vaccination with cowpox, a benign virus, was developed in the 1790s. Carrell's novelistic treatment of this story, which concludes with an account of the friendship that developed between Lady Mary and Boylston when he visited London in 1725, is engaging in spite of an overabundance of fabricated conversations and scenes that slow the action.
Copyright 2003 Reed Business Information, Inc.
From The New England Journal of Medicine
The severe epidemics of smallpox that swept through London and Boston in 1721 and 1722 caused scarring, blindness, and death. In Boston, almost 6000 people (out of a total population of 11,000) contracted smallpox, and more than 800 died. Doctors battled hopelessly against "the speckled monster" and applied the humoral therapies of bloodletting, blistering, and the so-called cool regimen, advocated by the distinguished English physician Thomas Sydenham. Into these geographically separate but similar scenes of chaotic misery stepped two unlikely heroes: Lady Mary Wortley Montagu, a highly intelligent, beautiful but pockmarked, English aristocrat, and Zabdiel Boylston, a locally trained colonial doctor. Lady Mary and Boylston promoted the new, exotic, and potentially dangerous practice of inoculation. (Figure) Inoculation was a folk practice that had been learned from Turkish women and African slaves, two groups generally deemed unreliable by both Europeans and colonial Americans. The practice involved taking a small amount of matter from a pustule of an infected person and inserting it into a scratch made in the skin of a healthy person. Usually a mild case developed and the infected person was thus protected for life from a severe case of natural smallpox. But the procedure was risky: contemporaries calculated that 1 of 91 persons infected in this manner died from the disease. Worse still, inoculated smallpox was contagious, something early inoculators soon discovered. But the horrible symptoms and the risks of dying from natural smallpox led Lady Mary and Boylston, among others, to try inoculation. Their conviction that this new procedure was safe and efficacious was dramatically demonstrated by their courage in administering it first to their own children. Numerous historians have written about this momentous revolution in medical practice. Inoculation laid the groundwork for vaccination, immunology, and medical statistics. Carrell's book, The Speckled Monster, adds a new twist to the topic; it is a fictional account based on extensive historical research (the subtitle of the book is "a historical tale"). Her narrative begins slowly but quickly picks up the pace as it interweaves events on both sides of the Atlantic and suggests their mutual influence. It is unapologetically heroic: Lady Mary and Boylston triumphed despite the substantial odds and obstacles against them. Lady Mary took on the formidable London medical establishment, whereas Boylston contended with providential clerics and foreign-trained physicians (particularly the cantankerous Scot, William Douglass). Both were threatened with mob violence. In sweeping and dramatic strokes, Carrell paints the ostracism Boylston endured as he made his rounds through colonial Boston; in England, Lady Mary suffered public criticism for daring to put her children deliberately in harm's way. The advantage of historical fiction is that it allows the author to recreate private conversations and psychological motivations that are often unavailable to historical analysis. Carrell has done this well, vividly reconstructing the horrors of smallpox and the hostility that often attends innovation. Her descriptions of sights, sounds, and smells envelop the reader in a tangible and immediate past. That said, Carrell freely admits to fabricating events and dialogue for which there is no evidence -- the most extreme instance (but one befitting a heroic narrative) is the contrived meeting and friendship between her two heroes, Lady Mary and Boylston, in London. The result is an enjoyable tale, but the historical truth is buried in the endnotes. Andrea Rusnock, Ph.D.
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